Depression affects 5 to 9 percent of primary care patients, and primary care doctors are the sole medical contact for more than half of patients with mental illness in the United States. Yet women with symptoms of depression are 72 percent more likely than symptomatic men to be diagnosed as depressed by their primary care doctor, according to a recent study supported by the Agency for Healthcare Research and Quality (HS06167 and HS08029). Women tended to have more depressive symptoms than men and also visited their doctor more often, which probably increased the likelihood of their depression being diagnosed, suggests Klea D. Bertakis, M.D., M.P.H., of the University of California, Davis, Center for Health Services Research in Primary Care.
Dr. Bertakis and her colleagues examined the absence or presence of depression diagnosis a year after the initial visit of 508 patients seeking care at a university medical center from 1990 to 1993. They interviewed the patients to determine sociodemographic characteristics, self-reported depressive symptoms, and general health status. Doctors diagnosed depression in only 28 percent of patients with moderate to severe depression (nine or more symptoms of depression). The average Beck Depression Inventory (BDI) score for the 36 patients recognized as depressed was significantly higher than the score for those not diagnosed as depressed (9.8 vs. 4.9), linking number of symptoms with likelihood of depression diagnosis.
Women had more self-reported symptoms of depression (6.4 vs. 4.3) and a higher mean number of primary care clinical visits (4.0 vs. 3.1) than men and were significantly more likely to be diagnosed as depressed (19 vs. 9 percent). Women with high BDI scores were significantly more likely than men with high BDI scores to be diagnosed as depressed. For both men and women, those with a greater number of primary care clinic visits were much more likely to be identified as depressed. These results suggest that a patient's sex has both a direct and an indirect (through increased clinic use) effect on the likelihood of being diagnosed as depressed.
See "Patient gender differences in the diagnosis of depression in primary care," by Dr. Bertakis, L. Jay Helms, Ph.D., Edward J. Callahan, Ph.D., and others, in the Journal of Women's Health & Gender-Based Medicine 10(7), pp. 689-698, 2001.