Recognition of major depressive disorder and its correlates among adult male patients in primary care

Sutanaya Pal,Rajat Oswal,Ganpat Vankar

doi:10.12740/app/89963

Abstract

Aim of the studyPrimary care is one of the first points of contact for patients with Major Depressive Disorder. However, before these centers can become effective referral points, it is essential to know the prevalence and current rates of detection there. We aimed to determine the prevalence of MDD and its sociodemographic correlates in a Primary Care Center and to evaluate the accuracy of the Primary Care Physicians’ diagnosis.Subject or material and methodsIt is an observational cross-sectional study conducted in a rural primary health care center on adult male attendees. PHQ-9 was used to screen for depression, which was confirmed by a psychiatrist who interviewed and diagnosed the patients using the DSM-5 criteria. Each patient was separately examined by the primary care physician who gave his/her opinion on whether the patient had depression or not.ResultsOut of 335 adult male patients, 22.1 percent screened positive with PHQ-9 and 42 patients (12.5 %) had Major Depression. The primary care physicians diagnosed only 45 percent of cases correctly, missing 55 percent. The correlation between the two PHC Physicians and the psychiatrist’s diagnosis had a Kappa of 0.342 and 0.281, respectively. Significant socio-demographic correlates were self-reported financial stress and life stressors.DiscussionThe prevalence found was consistent with studies done in other countries. The physicians’ diagnosis may have been an overestimation due to Hawthorne effect.ConclusionsThe primary care physician was unable to diagnose a significant fraction of the depression. This emphasizes the need for further training at this level, to catch the disease early and improve referral rates.

Highlights

Major depressive disorder (MDD) is one of the foremost causes of disability, ranking ninth in terms of total disability-adjusted life years (DALYs) [1]
The study was conducted over 6 months and included 335 adult male patients (Table 1)
The prevalence of MDD determined in this study is 12.5% (42 patients); 22.1% of the sample (74 patients) screened positive for Patient Health Questionnaire 9 (PHQ-9)

Summary

Introduction

Major depressive disorder (MDD) is one of the foremost causes of disability, ranking ninth in terms of total disability-adjusted life years (DALYs) [1]. The current rates of depression at the primary care level worldwide are estimated to be between 7.8 and 14.1% [2,3,4,5,6,7]. Few studies have looked into detection rates at the primary health care level. In Europe, primary care physicians were able to accurately detect 42– 51% of cases of depression [6,12,13]. The attending physician often failed to investigate physical symptoms in patients. In many cases, they were not trained to diagnose mental illness. They were not trained to diagnose mental illness These are some of the reasons hypothesized for low detection of mental illness in primary care

Methods

Results

Discussion

Conclusion