Summary
Background
Depression is a major burden for the health-care system worldwide. Most care for depression
is delivered by general practitioners (GPs). We assessed the rate of true positives
and negatives, and false positives and negatives in primary care when GPs make routine
diagnoses of depression.
Methods
We undertook a meta-analysis of 118 studies that assessed the accuracy of unassisted
diagnoses of depression by GPs. 41 of these studies were included because they had
a robust outcome standard of a structured or semi-structured interview.
Findings
50 371 patients were pooled across 41 studies and examined. GPs correctly identified
depression in 47·3% (95% CI 41·7% to 53·0%) of cases and recorded depression in their
notes in 33·6% (22·4% to 45·7%). 19 studies assessed both rule-in and rule-out accuracy;
from these studies, the weighted sensitivity was 50·1% (41·3% to 59·0%) and specificity
was 81·3% (74·5% to 87·3%). At a rate of 21·9%, the positive predictive value was
42·0% (39·6% to 44·3%) and the negative predictive value was 85·8% (84·8% to 86·7%).
This finding suggests that for every 100 unselected cases seen in primary care, there
are more false positives (n=15) than either missed (n=10) or identified cases (n=10).
Accuracy was improved with prospective examination over an extended period (3–12 months)
rather than relying on a one-off assessment or case-note records.
Interpretation
GPs can rule out depression in most people who are not depressed; however, the modest
prevalence of depression in primary care means that misidentifications outnumber missed
cases. Diagnosis could be improved by re-assessment of individuals who might have
depression.
Funding
None.
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Article Info
Publication History
Published: July 28, 2009
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