Detection of affective disorders in family practice: 126 assessments

Home visits provided the setting for interim assessments by a clinical psychiatrist and a research assistant between December 1978 and April 1979. Two instruments were used: a standardized 61-question interview and a self-rating checklist. Forty-seven cases of affective disorder, 47 age-sex-marital status matched compeers, and 32 spouses participated. Results show little agreement between family practice records (drug and problem lists) and assessment at home visits. Over 46 percent of adults showed signs of anxiety, depression, or both. Gaps in physician-patient communication account for some of the missed diagnoses. Prospective studies of these common disorders are handicapped by problems of: (1) definition and criteria, (2) fluctuations in sick/well status over time, (3) changing levels of severity and levels of detection, and (4) losses of the sicker persons from the population for follow-up study. A generally useful model for affective disorders emphasizes the interaction between intrinsic factors (subjective stress) and extrinsic factors (objective stress). A flow sheet is used to help the clinician assess the major components of stress, patient's ability to cope, and plan for management.