[How frequently are depressive disorders recognized in primary care patients? : A cross-sectional epidemiological study in Germany]. / Wie häufig werden Patienten mit depressiven Störungen in der hausärztlichen Praxis erkannt? : Eine epidemiologische Querschnittsstudie.

BACKGROUND: Primary care physicians (PCPs) play a crucial role for guideline-oriented intervention in patients with depression. OBJECTIVES: Based on a diagnostic screening questionnaire, this study investigates the sensitivity of PCPs to recognize patients with depression as well as the factors facilitating recognition and concordant diagnostic decisions. METHOD: In a cross-sectional epidemiological study in six regions of Germany, 3563 unselected patients filled in questionnaires on mental and physical complaints and were diagnostically evaluated by their PCP (N = 253). The patient reports on an established Depression-Screening-Questionnaire (DSQ), which allows the approximate derivation of an ICD-10 depression diagnosis, were compared with the physician diagnosis (N = 3211). In a subsample of discordant cases a comprehensive standardized clinical-diagnostic interview (DIA-X/CIDI) was applied. RESULTS: On the study day, the prevalence of ICD-10 depression was 14.3% according to the DSQ and 10.7% according to the physician diagnosis. Half of the patients identified by DSQ were diagnosed with depression by their physician and two thirds were recognized as mental disorder cases. More severe depression symptomatology and the persistent presence of main depression symptoms were related to better recognition and concordant diagnostic decisions. Diagnostic validation interviews confirmed the DSQ diagnosis in the majority of the false-negative cases. Indications for at least a previous history of depression were found in up to 70% of false-positive cases. CONCLUSION: Given the high prevalence of depression in primary care patients, there is continued need to improve the recognition and diagnosis of these patients to assure guideline-oriented treatment.

Tracing criteria of successful aging? Health locus of control and well-being in older patients with internal diseases.

To identify differences and similarities in health locus of control (HLC) and well-being between internistic patients, recently diagnosed cancer patients and healthy controls, we examined 110 patients with internal diseases, 196 cancer patients and 80 healthy controls aged 60+ years. HLC was assessed with the Multidimensional Health Locus of Control Scales (MHLC), well-being with the Positive and Negative Affect Schedule. Patients with internal diseases scored highest on internal HLC. Scores on social externalism and fatalism MHCL-subscales of internistic patients were similar to cancer patients. Both patient samples reported reduced positive affect. Higher levels of education, more social support, higher self-esteem, internal HLC and daily functioning predicted positive affect in the total sample. In addition, an interaction effect of internal locus of control and daily functioning was found in cancer patients. There were no group-specific predictors of positive affect. Results suggest that high internal HLC is associated with positive affect in each of the three samples. However, an internal HLC only contributes to positive affect in cancer patients when they are in sufficient physical condition to exert control over their health.