BMJ  2008;336:522 (8 March), doi:10.1136/bmj.39507.524711.80

Letters

Depression in adults

GPs are not so bad at diagnosis

The first 150 words of the full text of this article appear below.

Timonen and Liukkonen state that, according to cross sectional studies, 50-70% of patients with depression in primary care remain undetected.1 This attack on GPs’ ability to recognise depression is out of date and should not go unchallenged.

Studies have shown that many missed cases have relatively mild symptoms, that lie just above the threshold on screening measures for depression. These cases have dubious clinical relevance and may be false positives because all diagnostic measures have rating errors.2 In addition, cross sectional recognition rates are obtained from a single 10 minute consultation and usually exclude patients whom GPs have already recognised as depressed.

The article fails to acknowledge studies showing that many "missed" patients are diagnosed correctly at later visits. Kessler et al found that, although many patients with depression did not receive a diagnosis at a single consultation, most were given one at later consultations or recovered without a GP’s . . . [Full text of this article]

Tony Kendrick, professor of primary medical care

1 University of Southampton, Southampton SO16 5ST

a.r.kendrick@soton.ac.uk


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