Recognition of major depressive disorder and its correlates among adult male patients in primary care
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Medical College Baroda
Datta Meghe Institute of Medical Sciences, Wardha
Submission date: 2017-10-10
Final revision date: 2018-04-03
Acceptance date: 2018-04-16
Publication date: 2018-09-25
Corresponding author
Rajat M. Oswal   

Medical College Baroda, Department of Psychiatry, Medical College Baroda, Anandpura,, 390001 Vadodara, India
Arch Psych Psych 2018;20(3):55-62
Aim of the study:
Primary care is one of the first points of contact for patients with Major Depressive Disorder. However, before these centers can become effective referral points, it is essential to know the prevalence and current rates of detection there. We aimed to determine the prevalence of MDD and its sociodemographic correlates in a Primary Care Center and to evaluate the accuracy of the Primary Care Physicians’ diagnosis.

Subject or material and methods:
It is an observational cross-sectional study conducted in a rural primary health care center on adult male attendees. PHQ-9 was used to screen for depression, which was confirmed by a psychiatrist who interviewed and diagnosed the patients using the DSM-5 criteria. Each patient was separately examined by the primary care physician who gave his/her opinion on whether the patient had depression or not.

Out of 335 adult male patients, 22.1 percent screened positive with PHQ-9 and 42 patients (12.5 %) had Major Depression. The primary care physicians diagnosed only 45 percent of cases correctly, missing 55 percent. The correlation between the two PHC Physicians and the psychiatrist’s diagnosis had a Kappa of 0.342 and 0.281, respectively. Significant socio-demographic correlates were self-reported financial stress and life stressors.

The prevalence found was consistent with studies done in other countries. The physicians’ diagnosis may have been an overestimation due to Hawthorne effect.

The primary care physician was unable to diagnose a significant fraction of the depression. This emphasizes the need for further training at this level, to catch the disease early and improve referral rates.

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