Recognizing and managing depression in primary care a standardized patient study

Patricia A. Carney, Allen J. Dietrich, M. Scottie Eliassen, Mary Owen, Lee W. Badger

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


BACKGROUND. Guidelines for recognition and management of depression in primary care provide a framework for detailed exploration of physician practice patterns. METHODS. Our objective was to explore physician diagnosis and management approaches to depressive disorders according to type (major vs minor) and presenting complaint (difficulty sleeping and concentrating vs headache). The participants were community primary care internists and family physicians in northern New England, Washington, and Alabama (N = 149) who were randomly assigned to receive a visit from an unannounced actor portraying a standardized patient in 1 of 2 depression scenarios: (A) insomnia and poor concentration meeting Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for major depressive disorder; or (B) tension headaches meeting the criteria for minor depression. RESULTS. All physicians who were assigned to the standardized patients presenting with scenario A recognized depression, and 49% (38 of 78) of those assigned to scenario B patients diagnosed depression. Of those recognizing depression, 72% and 42% queried patients about anhedonia and mood, respectively. For both scenarios, if fewer than 2 DSM-III-R criteria were explored, depression was not diagnosed. Management for scenario A was compatible with Agency for Health Care Policy and Research guidelines, including the prescription of an antidepressant (94%), scheduling of a follow-up visit within 2 weeks (61%), and exploration of suicidal ideation (69.4%). For scenario B, management included over-the-counter analgesics for the headache (84%), exercise (63%), prescription for an antidepressant (53%), recommendation for ongoing counseling (100%), and follow-up within 2 weeks (42%). CONCLUSIONS. Major depression is recognized in primary care at a very high rate. Guidelines for recognizing and managing depression are often followed in primary care. Patients' presentations of depression influence its recognition and management.

Original languageEnglish (US)
Pages (from-to)965-972
Number of pages8
JournalJournal of Family Practice
Issue number12
StatePublished - Dec 1 1999
Externally publishedYes


  • Antidepressive agents
  • Depressive disorder
  • Practice guidelines

ASJC Scopus subject areas

  • Family Practice


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