Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2011 Feb;61(583):e72-80.
doi: 10.3399/bjgp11X556227.

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Alex J Mitchell  1 , Sanjay Rao, Amol Vaze
Affiliations
Meta-Analysis

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Alex J Mitchell et al. Br J Gen Pract. 2011 Feb.

Abstract

Background: There are international differences in the epidemiology of depression and the performance of primary care physicians but the factors underlying these national differences are uncertain.

Aim: To examine the international variability in diagnostic performance of primary care physicians when diagnosing depression in primary care.

Design of study: A meta-analysis of unassisted clinical diagnoses against semi-structured interviews.

Method: A systematic literature search, critical appraisal, and pooled analysis were conducted and 25 international studies were identified involving 8917 individuals. A minimum of three independent studies per country were required to aid extrapolation.

Results: Clinicians in the Netherlands performed best at case finding (the ability to rule in cases of depression with minimal false positives) (AUC+ 0.735) and this was statistically significantly better than the ability of clinicians in Australia (AUC+ 0.622) and the US (AUC+ 0.653), who were the worst performers. Clinicians from Italy had intermediate case-finding abilities. Regarding screening (the ability to rule out cases of no depression with minimal false negatives) there were no strong differences. Looking at overall accuracy, primary care physicians in Italy and the Netherlands were most successful in their diagnoses and physicians from the US and Australia least successful (83.5%, 81.9%, 74.3%, and 67.0%, respectively). GPs in the UK appeared to have the lowest ability to detect depression, as a proportion of all cases of depression (45.6%; 95% CI = 27.7% to 64.2%). Several factors influenced detection accuracy including: collecting data on clinical outcomes; routinely comparing the clinical performance of staff; working in small practices; and having long waits to see a specialist.

Conclusion: Assuming these differences are representative, there appear to be international variations in the ability of primary care physicians to diagnose depression, but little differences in screening success. These might be explained by organisational factors.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Plot of conditional probabilities for crossnational differences in rulein and rule-out accuracy of depression by GPs.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organization. Mental and neurological disorders. Geneva: Department of Mental Health and Substance Dependence; 2001.
    1. Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe —a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol. 2005;15(4):357–376. - PubMed
    1. Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. The global burden of mental disorders: an update from theWHOWorldMental Health (WMH) surveys. Epidemiol Psychiatr Soc. 2009;18(1):23–33. - PMC - PubMed
    1. Üstün TB, Von Korff M. Primary mental health services. In: Üstün TB, Sartorius N, editors. Mental illness in general health care: an international study. Chichester: JohnWiley & Sons; 1995. pp. 347–360.
    1. King M, Nazareth I, Levy G, et al. Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatr. 2008;192(5):362–367. - PubMed