Relatively little is known about the prevalence and correlates of overdiagnosis of depression in community settings. This study examined the extent to which individuals with clinician-identified depression in the community meet the criteria for DSM-IV major depressive episodes (MDE) and characteristics of these individuals. Methods:
In a sample of 5,639 participants with clinician-identified depression drawn from the 2009-2010 United States National Survey of Drug Use and Health, the proportion of participants who met the 12-month MDE criteria, ascertained by a structured interview, and variations in MDE diagnosis across different groups of participants were examined. Mental health profiles and service use of participants who met the MDE criteria were compared to those who did not meet these criteria. Results:
Only 38.4% of participants with 12-month clinician-identified depression met the 12-month MDE criteria. Older adults were less likely than younger adults to meet the criteria - only 14.3% of those 65 years old or older met the criteria, whereas participants with more education and those with poorer overall health were more likely to meet the criteria. Participants who did not meet the 12-month MDE criteria reported less distress and impairment in role functioning and used fewer services. A majority of both groups, however, were prescribed and used psychiatric medications. Conclusions:
Depression overdiagnosis and overtreatment is common in community settings in the USA. There is a need for improved targeting of diagnosis and treatments of depression and other mental disorders in these settings.
- Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A: Recognition of depression by non-psychiatric physicians - A systematic literature review and meta-analysis. J Gen Intern Med 2008;23:25-36.
- Mitchell AJ, Vaze A, Rao S: Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009;374:609-619.
- Goldberg D, Bridges K, Duncan-Jones P, Grayson D: Detecting anxiety and depression in general medical settings. BMJ 1988;297:897-899.
- Coyne JC, Schwenk TL, Smolinski M: Recognizing depression: a comparison of family physician ratings, self-report, and interview measures. J Am Board Fam Pract 1991;4:207-215.
- Coyne JC, Schwenk TL, Fechner-Bates S: Nondetection of depression by primary care physicians reconsidered. Gen Hosp Psychiatry 1995;17:3-12.
- Rost K, Zhang M, Fortney J, Smith J, Coyne J, Smith GR Jr: Persistently poor outcomes of undetected major depression in primary care. Gen Hosp Psychiatry 1998;20:12-20.
- Goldman LS, Nielsen NH, Champion HC: Awareness, diagnosis, and treatment of depression. J Gen Intern Med 1999;14:569-580.
- Williams JW Jr, Pignone M, Ramirez G, Perez Stellato C: Identifying depression in primary care: a literature synthesis of case-finding instruments. Gen Hosp Psychiatry 2002;24:225-237.
- Thombs BD, de Jonge P, Coyne JC, Whooley MA, Frasure-Smith N, Mitchell AJ, Zuidersma M, Eze-Nliam C, Lima BB, Smith CG, Soderlund K, Ziegelstein RC: Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA 2008;300:2161-2171.
- Thombs BD, Ziegelstein RC, Whooley MA: Optimizing detection of major depression among patients with coronary artery disease using the patient health questionnaire: data from the heart and soul study. J Gen Intern Med 2008;23:2014-2017.
- Tyrer P: Are general practitioners really unable to diagnose depression? Lancet 2009;374:589-590.
- Robbins JM, Kirmayer LJ, Cathebras P, Yaffe MJ, Dworkind M: Physician characteristics and the recognition of depression and anxiety in primary care. Med Care 1994;32:795-812.
- Berardi D, Menchetti M, Cevenini N, Scaini S, Versari M, De Ronchi D: Increased recognition of depression in primary care. Comparison between primary-care physician and ICD-10 diagnosis of depression. Psychother Psychosom 2005;74:225-230.
- Pratt LA, Brody DJ, Gu Q: Antidepressant use in persons aged 12 and over: United States, 2005-2008. 2011. http://www.cdc.gov/nchs/data/databriefs/db76.pdf.
- Paulose-Ram R, Safran MA, Jonas BS, Gu Q, Orwig D: Trends in psychotropic medication use among US adults. Pharmacoepidemiol Drug Saf 2007;16:560-570.
- Mojtabai R, Olfson M: Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff (Millwood) 2011;30:1434-1442.
- Mojtabai R: Increase in antidepressant medication in the US adult population between 1990 and 2003. Psychother Psychosom 2008;77:83-92.
- Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V: Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch Gen Psychiatry 2011;68:1104-1112.
- Monte S, Macchia A, Romero M, D'Ettorre A, Giuliani R, Tognoni G: Antidepressants and cardiovascular outcomes in patients without known cardiovascular risk. Eur J Clin Pharmacol 2009;65:1131-1138.
- Frank RG, Goldman HH, McGuire TG: Trends in mental health cost growth: an expanded role for management? Health Aff (Millwood) 2009;28:649-659.
- Parker G: Is depression overdiagnosed? Yes. BMJ 2007;335:328.
- Substance Abuse and Mental Health Services Administration: Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, Substance Abuse and Mental Health Services Administration, 2011. http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.pdf.
- Substance Abuse and Mental Health Services Administration: Results from the 2009 National Survey on Drug Use and Health. Volume 1: Summary of National Findings. Rockville, Office of Applied Studies, Substance Abuse and Mental Health Services Administration, 2010. http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsP.pdf.
- Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS: The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289:3095-3105.
- Wittchen HU: Reliability and validity studies of the WHO - Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 1994;28:57-84.
- Kessler RC, Walters EE: Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depress Anxiety 1998;7:3-14.
- Kessler RC, Zhao S, Blazer DG, Swartz M: Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord 1997;45:19-30.
- Rapaport MH, Judd LL, Schettler PJ, Yonkers KA, Thase ME, Kupfer DJ, Frank E, Plewes JM, Tollefson GD, Rush AJ: A descriptive analysis of minor depression. Am J Psychiatry 2002;159:637-643.
- Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002;32:959-976.
- Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand SL, Manderscheid RW, Walters EE, Zaslavsky AM: Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184-189.
- Kessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M, Furukawa TA, Gureje O, Hinkov H, Hu CY, Lara C, Lee S, Mneimneh Z, Myer L, Oakley-Browne M, Posada-Villa J, Sagar R, Viana MC, Zaslavsky AM: Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative. Int J Methods Psychiatr Res 2010;19(Suppl 1): 4-22.
- Novak SP, Colpe LJ, Barker PR, Gfroerer JC: Development of a brief mental health impairment scale using a nationally representative sample in the USA. Int J Methods Psychiatr Res 2010;19(Suppl 1):49-60.
- Aldworth J, Colpe LJ, Gfroerer JC, Novak SP, Chromy JR, Barker PR, Barnett-Walker K, Karg RS, Morton KB, Spagnola K: The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration analysis. Int J Methods Psychiatr Res 2010;19(Suppl 1):61-87.
- Colpe LJ, Barker PR, Karg RS, Batts KR, Morton KB, Gfroerer JC, Stolzenberg SJ, Cunningham DB, First MB, Aldworth J: The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration study design and field procedures. Int J Methods Psychiatr Res 2010;19(suppl 1):36-48.
- Colpe LJ, Epstein JF, Barker PR, Gfroerer JC: Screening for serious mental illness in the National Survey on Drug Use and Health (NSDUH). Ann Epidemiol 2009;19:210-211.
- First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). New York, Biometrics Research, New York State Psychiatric Institute, 2002.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
- Endicott J, Spitzer RL, Fleiss JL, Cohen J: The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976;33:766-771.
- StataCorp: Stata Statistical Software, Release 12. College Station, Stata Corporation, 2011.
- Zimmerman M, Galione J: Psychiatrists' and nonpsychiatrist physicians' reported use of the DSM-IV criteria for major depressive disorder. J Clin Psychiatry 2010;71:235-238.
- Wittchen HU, Hofler M, Meister W: Prevalence and recognition of depressive syndromes in German primary care settings: poorly recognized and treated? Int Clin Psychopharmacol 2001;16:121-135.
- Turrina C, Caruso R, Este R, Lucchi F, Fazzari G, Dewey ME, Ermentini A: Affective disorders among elderly general practice patients. A two-phase survey in Brescia, Italy. Br J Psychiatry 1994;165:533-537.
- Bushnell J: Frequency of consultations and general practitioner recognition of psychological symptoms. Br J Gen Pract 2004;54:838-843.
- Zimmerman M, Galione JN, Chelminski I, McGlinchey JB, Young D, Dalrymple K, Ruggero CJ, Witt CF: A simpler definition of major depressive disorder. Psychol Med 2010;40:451-457.
- Dowrick C, Leydon GM, McBride A, Howe A, Burgess H, Clarke P, Maisey S, Kendrick T: Patients' and doctors' views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study. BMJ 2009;338:b663.
- Rait G, Walters K, Griffin M, Buszewicz M, Petersen I, Nazareth I: Recent trends in the incidence of recorded depression in primary care. Br J Psychiatry 2009;195:520-524.
- Zimmerman M: Symptom severity and guideline-based treatment recommendations for depressed patients: implications of DSM-5's potential recommendation of the PHQ-9 as the measure of choice for depression severity. Psychother Psychosom 2012;81:329-332.
- Mojtabai R, Olfson M: Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychol Med 2004;34:623-634.
- Aneshensel CS, Frerichs RR, Huba GJ: Depression and physical illness: a multiwave, nonrecursive causal model. J Health Soc Behav 1984;25:350-371.
- Muntaner C, Eaton WW, Miech R, O'Campo P: Socioeconomic position and major mental disorders. Epidemiol Rev 2004;26:53-62.
- Griffiths KM, Christensen H, Jorm AF: Predictors of depression stigma. BMC Psychiatry 2008;8:25.
- Olfson M, Marcus SC: National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009;66:848-856.
- Middleton H, Moncrieff J: ‘They won't do any harm and might do some good': time to think again on the use of antidepressants? Br J Gen Pract 2011;61:47-49.
- Nutt D: Massive overuse or appropriate medical intervention? The modern-day use of antidepressants. Curr Opin Pharmacol 2012;12:109-110.
- Milea D, Verpillat P, Guelfucci F, Toumi M, Lamure M: Prescription patterns of antidepressants: findings from a US claims database. Curr Med Res Opin 2010;26:1343-1353.
- Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M: Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry 2011;198(suppl 11): 11-16.
- Hegerl U, Schonknecht P, Mergl R: Are antidepressants useful in the treatment of minor depression: a critical update of the current literature. Curr Opin Psychiatry 2012;25: 1-6.
- van der Lem R, van der Wee NJ, van Veen T, Zitman FG: Efficacy versus effectiveness: a direct comparison of the outcome of treatment for mild to moderate depression in randomized controlled trials and daily practice. Psychother Psychosom 2012;81:226-234.
- Gribbin J, Hubbard R, Gladman J, Smith C, Lewis S: Serotonin-norepinephrine reuptake inhibitor antidepressants and the risk of falls in older people: case-control and case-series analysis of a large UK primary care database. Drugs Aging 2011;28:895-902.
- Gagne JJ, Patrick AR, Mogun H, Solomon DH: Antidepressants and fracture risk in older adults: a comparative safety analysis. Clin Pharmacol Ther 2011;89:880-887.
- Hartikainen S, Lonnroos E: Systematic review: use of sedatives and hypnotics, antidepressants and benzodiazepines in older people significantly increases their risk of falls. Evid Based Med 2010;15:59.
- Caughey GE, Roughead EE, Shakib S, McDermott RA, Vitry AI, Gilbert AL: Comorbidity of chronic disease and potential treatment conflicts in older people dispensed antidepressants. Age Ageing 2010;39:488-494.
- Nishtala PS, McLachlan AJ, Bell JS, Chen TF: Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry 2008;16:621-632.
- Mojtabai R: Does depression screening have an effect on the diagnosis and treatment of mood disorders in general medical settings? An instrumental variable analysis of the National Ambulatory Medical Care Survey. Med Care Res Rev 2011;68:462-489.
- Katon W, Rutter CM, Lin E, Simon G, Von Korff M, Bush T, Walker E, Ludman E: Are there detectable differences in quality of care or outcome of depression across primary care providers? Med Care 2000;38:552-561.
- Batstra L, Frances A: Holding the line against diagnostic inflation in psychiatry. Psychother Psychosom 2012;81:5-10.
- National Institute for Health and Clinical Excellence (Great Britain): Depression: The Treatment and Management of Depression in Adults.2012. http://publications.nice.org.uk/depression-cg90/guidance#step-1-recognition-assessment-and-initial-management.
- National Health Services: Improving Access to Psychological Therapies. 2011. http://www.iapt.nhs.uk/.
- Mojtabai R: Americans' attitudes toward psychiatric medications: 1998-2006. Psychiatr Serv 2009;60:1015-1023.
- Ghods BK, Roter DL, Ford DE, Larson S, Arbelaez JJ, Cooper LA: Patient-physician communication in the primary care visits of African Americans and whites with depression. J Gen Intern Med 2008;23:600-606.
- Eaton WW, Hall AL, Macdonald R, McKibben J: Case identification in psychiatric epidemiology: a review. Int Rev Psychiatry 2007;19:497-507.
- Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC: Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 2006;15:167-180.
- Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC: Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:629-640.
- Tiemens BG, VonKorff M, Lin EH: Diagnosis of depression by primary care physicians versus a structured diagnostic interview. Understanding discordance. Gen Hosp Psychiatry 1999;21:87-96.
- Levkovitz Y, Tedeschini E, Papakostas GI: Efficacy of antidepressants for dysthymia: a meta-analysis of placebo-controlled randomized trials. J Clin Psychiatry 2011;72:509-514.
- Eaton WW, Shao H, Nestadt G, Lee HB, Bienvenu OJ, Zandi P: Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry 2008;65:513-520.
- Moore M, Yuen HM, Dunn N, Mullee MA, Maskell J, Kendrick T: Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. BMJ 2009;339:b3999.
- Barry CL, Huskamp HA: Moving beyond parity - Mental health and addiction care under the ACA. N Engl J Med 2011;365:973-975.
Ramin Mojtabai, MD
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
624 North Broadway, Hampton House/Room 797
Baltimore, MD 21205 (USA)
Received: May 27, 2012
Accepted after revision: November 15, 2012
Published online: March 27, 2013
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 2, Number of References : 78
Psychotherapy and Psychosomatics
Vol. 82, No. 3, Year 2013 (Cover Date: April 2013)
Journal Editor: Fava G.A. (Bologna)
ISSN: 0033-3190 (Print), eISSN: 1423-0348 (Online)
For additional information: http://www.karger.com/PPS
Copyright / Drug Dosage
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.