Make the Diagnosis: Depression
Although most depression screening focuses on major depressive disorders, a number of treatable conditions may be detected by depression screening. In primary care, the combined prevalence of depression and dysthymia is approximately 7% to 12% (Table 19-7).
Table 19-7Prevalence of Depression and Dysthymia in Primary Care ||Download (.pdf) Table 19-7 Prevalence of Depression and Dysthymia in Primary Care
|Illness ||Prevalence, % |
|Major depressive disorder ||4.8-8.6 |
|Dysthymic disorder ||2.1-3.7 |
|Depression NOS ||4.4-5.4 |
Populations for Whom Depression Should Be Assessed
Detecting the Likelihood of Major Depressive Disorder or Dysthymia
Table 19-8Likelihood Ratios for Detecting Major Depressive Disorder ||Download (.pdf) Table 19-8 Likelihood Ratios for Detecting Major Depressive Disorder
|Instrument and Threshold ||Summary LR+ (95% CI) or Range ||Summary LR– (95% CI) or Range |
|PHQ-9 (score ≥ 10 is positive)a ||4.9-7.3 ||0.02-0.14 |
|PRIME-MD (score ≥ 1 is positive) ||2.6 (2.1-3.2) ||0.15 (0.08-0.28) |
Detecting the Likelihood of Major Depressive Disorder
Table 19-9Likelihood Ratios for Detecting Major Depressive Disorder or Dysthymia ||Download (.pdf) Table 19-9 Likelihood Ratios for Detecting Major Depressive Disorder or Dysthymia
|Instrument ||Summary LR+ (95% CI) ||Summary LR– (95% CI) |
|PHQ-9 (score ≥ 10 is positive) ||5.9 (4.2-8.3) ||0.29 (0.23-0.38) |
A structured (eg, Diagnostic Interview Schedule) or semistructured diagnostic interview (eg, Structured Clinical Interview for DSM-IV) to establish diagnoses.
Original Article: Is This Patient Clinically Depressed?
Mr P is a 52-year-old small-business owner with a 5-year history of controlled hypertension, for which he takes a thiazide diuretic. Otherwise, he is in good health. He presents for routine follow-up and notes a 1-month history of mild to moderate bitemporal headaches and feeling fatigued. The headaches occur about twice a week and are relieved by acetaminophen. He denies chest pain or dyspnea on exertion. He notes wryly that the “new economy” has left him feeling a bit “frazzled.”
You wonder whether the headache and fatigue are stress related, a somatic presentation of depression. What is the most effective ...