Diagnosis of depression by primary Care physicians versus a structured Diagnostic interview : Understanding discordance.
In this paper, false-negative and false-positive cases of depressive illness are examined, differentiating levels of disagreement between a primary care physician's diagnosis and a standardized research diagnosis.
Two stratified random samples of primary care patients in Seattle, USA (N=373) and Groningen, The Netherlands (N=340) were examined with the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC).
Physician's severity ratings and diagnosis of psychological disorder were obtained.
Three levels of disagreement between physician and CIDI diagnosis were distinguished : 1) complete disagreement about the presence of psychiatric symptoms (true false-negative and true false-positive patients) ; 2) disagreement over severity of recognized psychological illness (underestimated or overestimated) ; and 3) disagreement over the specific psychiatric diagnosis among those given a diagnosis (misdiagnosed or given another CIDI diagnosis).
All three levels of disagreement were common.
Only 27% of the false-negative cases were due to complete disagreement (true false-negatives), and 55% of the false-positives were due to complete disagreement (true false-positives).
The true false-negative patients were younger, more often employed, rated their own health more favorably, visited their doctor for a somatic complaint and made fewer visits than the underestimated, misdiagnosed, and concordant positive patients. (...)
Mots-clés Pascal : Etat dépressif, Diagnostic, Médecin généraliste, Etude comparative, Entretien directif, Psychométrie, Accord interjuge, Soin santé primaire, Homme, Trouble humeur
Mots-clés Pascal anglais : Depression, Diagnosis, General practitioner, Comparative study, Directive interview, Psychometrics, Interrater agreement, Primary health care, Human, Mood disorder
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0349333
Code Inist : 002B18C07A. Création : 14/12/1999.