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Doctors Overlook Half of Depressed Patients With PM-CDC--Smoking Survey, Bjt

LEE SIEGELDecember 15, 1989

SANTA MONICA, Calif. (AP) _ Researchers say physicians fail to diagnose severe depression in half the patients who suffer the most common mental illness, and the problem is worse in prepaid health plans.

″Depression is quite serious, it’s eminently treatable, and yet we’re finding only half of patients are detected″ by doctors who are paid fees based on how much care they provide patients, said Dr. Kenneth Wells, the study’s chief author.

Only two-fifths of depressed patients were recognized by general practitioners, internists and other non-mental health specialists who were paid fixed fees in advance, regardless of how much care they provided, he added.

Such doctors include those working for health maintenance organizations, or HMOs, and also physicians who provide prepaid care in solo and group practices.

The study, published in today’s Journal of the American Medical Association, involved 650 severely depressed patients and more than 500 doctors in Los Angeles, Chicago and Boston. It was conducted by researchers from the Rand Corp. in Santa Monica; the University of California, Los Angeles; and New England Medical Center Hospitals in Boston.

Compared with general medical doctors’ frequent failure to detect depression, psychiatrists and psychologists recognized more than 83 percent of seriously depressed patients, the researchers found.

Such mental health specialists were equally likely to detect and treat depressed people regardless of how they were paid, said Wells, a UCLA psychiatrist and senior researcher at Rand.

″I know depression is missed,″ said Dr. Charles McElwee, president of the Los Angeles County Medical Association. ″All doctors have to be on the lookout for the depressed patient. This study will help raise everybody’s level of awareness.″

Stuart Byer, president of the California Association of HMOs, said he couldn’t explain why prepaid doctors were less likely than others to recognize depression.

But he said other studies show doctors in HMOs - which were established to control spiraling medical costs - ″deliver better care by not overprescribin g drugs, procedures and hospitalization.″

Although everyone feels sad at times, 9.4 million Americans suffer clinical depression during any six-month period, according to the American Psychiatric Association, which calls depression ″the most common and treatable of all mental illnesses.″

″One in four women and one in 10 men can expect to develop it during their lifetime. Between 80 percent and 90 percent of those who suffer depression can be effectively treated″ by medication or psychotherapy, an APA pamphlet said.

Each year, depression spurs 20,000 suicides and costs $16 billion in lost productivity and medical expenses in the United States, a 1985 study found.

Wells said depressed patients in his study felt sad ″all the time every day for at least two weeks, and also had at least three other symptoms of depression such as poor sleep or appetite, suicidal thoughts, difficulty concentrating, having no interest in things you normally enjoy.″

The researchers evaluated 22,462 patients who visited doctors regularly, using detailed diagnostic interviews to pick a representative sample of 650 severely depressed people.

Studies in individual hospitals or clinics previously found doctors often don’t recognize depression. Wells said his study is easily the largest and the first to cover all major types of medical practice.

He found general medical doctors paid on a fee-for-service basis detected only 54 percent of depressed patients, and prepaid doctors recognized only 42 percent of such people.

Wells speculated some doctors view treatment of depression as optional because some patients get well without help. Prepaid plans are meant to save money, so doctors working for such plans may be even less likely than others to watch for signs of depression, he said.

HMO doctors ″are not encouraged to underserve patients,″ Byer said. ″Doctors are encouraged to deliver the right care.″

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