Diagnostic accuracy and adequacy of treatment of depressive and anxiety disorders: A comparison of primary care and specialized care patients.

Background: Clinical diagnosis of depressive and anxiety disorders has poor sensitivity, and treatment is often not guideline-concordant. This longitudinal study aims to compare diagnostic validity and treatment adequacy in primary care (PC) and specialized care (SC), to assess associated risk factors, and to evaluate their impact on clinical outcome at one-month and three-month follow-ups.

Methods: Two hundred twelve patients with depressive and anxious symptoms were recruited from 3 PC and 1 SC centers in Barcelona, Spain. Sensitivity and specificity were calculated comparing medical records׳ diagnoses with a reference (MINI interview). Adequate treatment was defined according to clinical guidelines. Logistic regression was used to estimate associations with risk factors. Impact on outcome was assessed with MANOVA models.

Results: Valid diagnosis of depression was more frequent in patients attending SC. Sensitivity for depression was 0.75 in SC and 0.49 in PC (adjusted OR=17.34, 95% CI=4.73-63.61). Detection of anxious comorbidity in depressed patients was low (50%) in SC. Treatment adequacy of depressive disorders was higher in SC than in PC (94.4% vs. 80.6%, adjusted OR=8.11, 95% CI=1.39-47.34). Depression severity was associated with valid diagnosis.

Limitations: Only four disorders (major depression, dysthymia, panic disorder and generalized anxiety disorder) were evaluated with the MINI interview in a convenience clinical sample. Treatment dosage was unavailable.

Conclusions: Our results suggest that GPs need tools to improve detection of depression and its severity. Psychiatrists should enhance recognition of anxious comorbidity. Evaluation of the impact on outcome deserves further research.