Depression often undiagnosed, as symptoms vary among patients

Physicians need to be more attentive to changes in patients' behaviors and ask probing questions to improve recognition and treatment of depression, a new study says.

People with depression often do not recognize they have a problem, or are unable to describe their distress, which can lead to delays in seeking treatment, according to a study published online May 15 in the Journal of General Internal Medicine. Nationwide, one in four people with major depression is undiagnosed, and fewer than half with the condition receive treatment.

Researchers urge doctors to remember that patients exhibit different symptoms of the illness. They recommend that physicians explain to patients the factors that make some people more vulnerable to depression and assure them that the illness can be treated (link).

"A doctor will say, 'Do you feel depressed?' And if the patient says, 'No,' a lot of doctors will [think] 'OK, they're not depressed.' We're saying, look a little beneath the surface. Ask another question," said lead study author Ronald Epstein, MD. He is a professor of family medicine, psychiatry, oncology and nursing at the University of Rochester Medical Center in New York. He also is director of the Rochester Center to Improve Communication in Health Care at the medical center.

Dr. Epstein asks patients what activities they enjoy and when they last participated in them. He inquires whether the activity was enjoyable the last time. If it wasn't, he asks the patient, "What do you think is going on?"

For the study, researchers examined data on 116 adults age 25 to 64 who reported a history of depression or had experience with a close friend or relative who was depressed. Researchers found that 80% of participants thought they needed help for emotional or mental health issues during the past year, and 62% of those respondents received treatment. Overall, 87% had been treated for depression at some point in their lives with counseling and medication. Thirty percent of those who were treated said it was beneficial.

The American College of Preventive Medicine recommends that primary care physicians screen all adult patients for depression. About 15 million people -- 6.7% of U.S. adults -- experience depression in any given year. Primary care physicians are the principal health care contacts for most of these patients, according to the position statement published in the October 2009 Journal of Family Practice, (link).