Diagnosing Major Depression: Is the DSM Underused?

Leslie Citrome, MD, MPH


April 12, 2010

Psychiatrists' and Nonpsychiatrist Physicians' Reported Use of the DSM-IV Criteria for Major Depressive Disorder

Zimmerman M, Galione J
J Clin Psychiatry. 2010;71:235-238


This study contrasts the use of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for major depressive disorder (MDD) between 291 psychiatrists and 40 nonpsychiatrist physicians. All participants attended a continuing medical education (CME) conference in 2006 or 2007 on the treatment and management of depression; prior to a lecture, the subjects completed a questionnaire. Nearly one quarter of the psychiatrists indicated that they usually did not use the DSM-IV MDD criteria when diagnosing depression, and nearly half of the nonpsychiatrist physicians indicated that they rarely used the DSM-IV MDD criteria to diagnose depression. Psychiatrists who reported using the DSM-IV criteria less than 25% of the time were the oldest group (mean, 62.1 years) and in practice for the longest amount of time, whereas the psychiatrists who reported using the DSM-IV criteria more than 75% of the time were the youngest group (mean, 54.3 years).


The authors found that a substantial minority of psychiatrists and the majority of nonpsychiatrist physicians often do not use the DSM-IV MDD criteria when diagnosing depression. This is not surprising -- making a diagnosis in a clinical setting does not usually involve using an instrument such as the Structured Clinical Interview for DSM-IV Axis I Disorders or even a checklist. However, not using some sort of structured approach can unfortunately lead to misdiagnosis. This has been amply demonstrated by work done regarding the underidentification of bipolar depression, where the recommended treatment differs greatly from that for MDD. Moreover, if depressive symptoms are not systematically assessed, missing residual symptoms will decrease the opportunity for remission and thus expose the patient to a higher risk for relapse. In the published report, results of a "pre-test" were provided. It would be interesting to see the results of any "post-test" and whether participation in the CME conference had any impact on physician behaviors regarding diagnosis of MDD.



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.