http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9293240&fileId=S1463423613000285
Research
Clinical cues for detection of people with undiscovered depression in primary health care: a case–control study
Lena Flyckta1 c1, Ejda Hasslera2, Louise Lotfia2, Ingvar Krakaua2 and Gunnar H. Nilssona2 a1 Department of Clinical Neuroscience, Stockholm Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden a2 Department of Neurobiology, Care Science and Society, Centre for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden
Abstract
Aim To identify clinical cues indicative of depression in medical records of cases in primary care with undetected depression.
Background Depressive disorders are common; the lifetime risk for men and women is 27% and 45%, respectively. Despite effective treatment methods such as antidepressants and cognitive behavioural therapy, depression often remains undiscovered in primary care, with great implications both on the individual and societal level.
Methods Clinical cues indicating depression were sought in medical records the year before an opportunistic screening for depression in primary care. In a previous study of 221 patients in the waiting room of a primary care centre during 10 randomly selected days, 45 (20%) showed signs of depression (MADRS-S ≥ 12) and 60% of these were verified as having depressive disorders (Prime-MD). These 45 patients constitute the cases in the present study. Age- and gender-matched controls were selected among those who scored below the chosen cut-off level.
Findings Seventeen (38%) of the 45 cases compared with eight (18%) of the 45 controls had one or more cues [odds ratio (OR) 2.81; 95% confidence interval (CI): 1.06–7.43]. Sleep disturbance showed the greatest difference between cases and controls (OR 4.53; 95% CI: 1.17–17.55). A