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Psychosocial Interest, Medical Interviews, and the Recognition of Depression
Lee W. Badger, PhD;
Frank V. deGruy, MD;
Julia Hartman, MA;
Mary Ann Plant, PhD;
James Leeper, PhD;
Roland Ficken, PhD;
Alan Maxwell, MD;
Elizabeth Rand, MD;
Russell Anderson, MD;
Bryce Templeton, MD
Arch Fam Med. 1994;3(10):899-907.
Abstract
Objectives
To measure primary care physicians' attitudes toward psychosocial issues, determine their relationship to the style of the medical interview, and assess whether attitudes and interview behaviors lead to correct diagnosis in patients with depression.
Design
Physicians were videotaped while interviewing four patients standardized with criteria symptoms of major depression. Physicians were unaware of the mental health focus of the study.
Setting
Patient examining rooms.
Participants
Physicians were eligible for recruitment if they were board certified or eligible in family practice or internal medicine, practiced primary care medicine, and were listed in regional directories. Standardized patients were recruited from the community.
Main Outcome Measures
Attitudes toward psychosocial issues (measured by the Physician Belief Scale), interview content (measured by review of the videotaped encounters), interview behaviors (measured by the Interaction Analysis System for Interview Evaluation), and a listing of depression in the differential diagnosis (determined by physician debriefing interview).
Results
Forty-seven community-based practitioners participated. Forty-eight percent of interviews resulted in a diagnosis of depression. Physician Belief Scale scores were not significantly correlated with patientcentered interviewing, psychosocial questions, inquiry about depression symptoms, or a depression diagnosis. Longer interviews were more likely to result in a depression diagnosis.
Conclusions
High interest in psychosocial issues was not associated with patient-centered interviewing behaviors, questions about psychosocial or depression symptoms, or depression diagnoses. However, certain patientcentered interviewing behaviors, particularly those defined as "affective," did lead to the recognition of depression.
Author Affiliations
From the School of Social Work, University of Alabama, Tuscaloosa (Dr Badger); the Department of Family Medicine, University of South Alabama School of Medicine, Mobile (Dr deGruy); the Departments of Behavioral and Community Medicine (Ms Hartman and Drs Leeper and Ficken), Psychiatry (Drs Plant and Rand), and Family Medicine (Drs Maxwell and Anderson), Tuscaloosa Program, University of Alabama School of Medicine; and the Department of Mental Health Science, Hahnemann University, Philadelphia, Pa (Dr Templeton).
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