ABSTRACT
BACKGROUND: Underrecognition and undertreatment of depression in primary care has been regarded as a major public health problem. In contrast, some studies found that among patients labeled as depressed by primary-care physicians (PCPs), a relevant proportion do not satisfy international diagnostic criteria for depression. The aims of this study are: (1) to assess disparity between PCP diagnosis and research diagnosis of depression; (2) to compare antidepressant treatment in concordant and discordant cases of depression. METHODS: Data are gathered from a national survey on depressive disorders in primary care, conducted with the collaboration of 191 PCPs. Three hundred and sixty-one PCP patients were evaluated, and their psychiatric diagnosis was established by the 'unaided' PCPs and by using a research interview for depression. RESULTS: PCPs recognized 79.4% of cases of depression and prescribed antidepressants to 40.9% of them. Yet, 45.0% of patients labeled as depressed by the PCPs were not cases of depression according to ICD-10 criteria; 26.9% of false-positive cases received an antidepressant. Globally, 35% of antidepressants for 'depression' were prescribed to false-positive cases. CONCLUSIONS: Underrecognition and undertreatment of depression in primary care seem to be less alarming. Conversely, PCP diagnoses of depression appear to be more inclusive than psychiatric diagnostic criteria. A possible consequence of this apparently more inclusive diagnostic threshold may be an excessive use of antidepressants. These changes require a corresponding change in research, toward efficacy and safety of the treatment of milder cases, and in education, toward the distinction between the management of mild and severe cases of depression.
Subject(s)
Depressive Disorder/diagnosis , Diagnostic Errors , Physicians, Family , Adult , Algorithms , Antidepressive Agents/therapeutic use , Clinical Competence , Depressive Disorder/drug therapy , Depressive Disorder/psychology , False Positive Reactions , Female , Health Surveys , Humans , International Classification of Diseases , Interview, Psychological , Italy , Male , Middle Aged , Physicians, Family/educationABSTRACT
OBJECTIVE: To evaluate the prevalence of dementia among persons born in the year 1930 or before, who were living in Granarolo, Ravenna province, on December 31, 1991. DESIGN: Population study, carried out in two phases: in the first was phase all persons were administered two screening tests for dementia. In the second phase, persons who screened positive underwent detailed clinical and cognitive assessments. MAIN OUTCOME MEASURES: The Mini Mental State Examination (MMSE) and the Global Deterioration Scale (GDS) were administered as screening tests. In the second phase the screened-positive subjects underwent a general and neurological examination, and a detailed neuropsychological assessment. RESULTS: Of the 557 participants, 56 were clinically diagnosed as demented. Twenty-nine persons were diagnosed as affected by Alzheimer's disease (AD) and 14 patients by vascular dementia (VaD). The crude prevalence ratios for dementia were 9.1% (95% C.I. = 5.29-12.89) for men and 12.7% (95% C.I. = 8.84-16.6) for women. The prevalence of all dementias, as well as AD, increased steeply every five years of age for both men and women up to 90 years of age. Women had higher prevalence of all dementias and AD than men, more evident in the advanced ages. CONCLUSIONS: Our findings are in agreement with similar studies carried out in European populations, showing that prevalence of dementia increases with increasing age. If we consider that in Italy the oldest (those 80 years and older) are the fastest growing part of the elderly population, we can expect that dementia will be a major emerging public health problem, as it is one of the most common diseases in the very elderly and a major cause of disability and mortality.
