Prevalence of depression and clues to focus diagnosis. A study among Dutch general practice patients 65+ years of age.

AIMS: To assess the prevalence of depression in elderly patients presenting in general practice, and to assess which patient characteristics and presenting symptoms are useful clues for predicting depression.

DESIGN

Cross-sectional survey based on data collected at the presenting consultation and at a subsequent domiciliary interview.

SUBJECTS AND

SETTING

580 of 706 consecutive patients aged 65+ years consulting 13 general practitioners in the Netherlands.

METHOD: GPs entered data on presenting symptoms and their assessment of psychological state during the consultation. Formal psychiatric assessment was subsequently done at home using the Diagnostic Interview Schedule (plus additional questions to assess minor depression according to ICHPPC-2-Defined). Major depression and dysthymia were assessed with the Diagnostic Interview Schedule.

RESULTS

The estimated prevalence of depression (both major and minor plus dysthymia) was 7.9%, and was very similar whether based on GP assessment or formal validated interview schedule, but the GPs did not identify the same patients as the formal psychiatric assessment. GPs identified only 26% (95% CI 4-71%) of patients with major depression. Clinical clues which could help the GP to suspect underlying depression were female gender, the presentation of vague symptoms, and gastrointestinal symptoms.

CONCLUSIONS

Although presentation of symptoms does provide some clues about the likelihood of underlying depression, the sensitivity of GP diagnosis remains low and needs to be improved.