Recognition of major depressive disorder and its correlates among adult male patients in primary care

Background and aims. Primary care is one of the first points of contact for patients with major depressive disorder (MDD). However, before primary care centers can become effective referral points, it is essential to know the prevalence and current rates of detection of MDD in those centers. We aimed to determine the prevalence of MDD and its sociodemographic correlates in a primary care center and to evaluate the accuracy of the primary care physicians' diagnosis. Methodology. This is an observational cross-sectional study conducted in a rural primary health care center on adult male attendees. PHQ-9 was used to screen for depression, which was confirmed by a psychiatrist who interviewed and diagnosed patients using the DSM-5 criteria. A primary care physician separately examined each patient for depression. Results. Out of 335 adult male patients, 22.1% screened positive with PHQ-9 and 42 patients (12.5 %) had MDD Primary care physicians diagnosed only 45% of cases correctly, missing 55%. The correlation between the two physicians' and the psychiatrist's diagnosis had a Kappa of 0.342 and 0.281, respectively. Significant sociodemographic correlates were self-reported financial stress and life stressors. Discussion. MDD prevalence was consistent with studies in other countries. The physicians' diagnosis may have been an overestimation due to the Hawthorne effect. Conclusion. Primary care physicians were unable to diagnose a significant fraction of the depression. This emphasizes the need for further training at this level, to improve early diagnosis and referral rates.