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Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment.

Link, CL, Stern, TA, Piccolo, RS, Marceau, LD, Arber, S, Adams, A, Siegrist, J, von dem Knesebeck, O and McKinlay, JB (2011) Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment. Primary Care Companion CNS Disord, 13 (5).

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Abstract

Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a "patient" with exactly the same symptoms indicative of depression in 3 different health care systems (Germany, the United Kingdom, and the United States).Method: A factorial experiment was conducted between 2001 and 2006 in which 384 randomly selected primary care physicians viewed a video vignette of a patient presenting with symptoms suggestive of depression. Under the supervision of experienced clinicians, professional actors were trained to realistically portray patients who presented with 7 symptoms of depression: sleep disturbance, decreased interest, guilt, diminished energy, impaired concentration, poor appetite, and psychomotor agitation or retardation.Results: Most physicians listed depression as one of their diagnoses (89.6%), but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (P = .0251). American physicians were almost twice as likely to prescribe an antidepressant as British physicians (P = .0241). German physicians were significantly more likely to refer the patient to a mental health professional than British or American physicians (P < .0001). German physicians wanted to see the patient in follow-up sooner than British or American physicians (P < .0001).Conclusions: Primary care physicians in different countries diagnose the exact same symptoms of depression differently depending on the patient's gender. There are also significant differences between countries in the management of a patient with symptoms suggestive of depression. International differences in prevalence rates for depression, and perhaps other diseases, may in part result from differences among health care systems in different countries.

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > Department of Sociology
Authors :
AuthorsEmailORCID
Link, CLUNSPECIFIEDUNSPECIFIED
Stern, TAUNSPECIFIEDUNSPECIFIED
Piccolo, RSUNSPECIFIEDUNSPECIFIED
Marceau, LDUNSPECIFIEDUNSPECIFIED
Arber, SUNSPECIFIEDUNSPECIFIED
Adams, AUNSPECIFIEDUNSPECIFIED
Siegrist, JUNSPECIFIEDUNSPECIFIED
von dem Knesebeck, OUNSPECIFIEDUNSPECIFIED
McKinlay, JBUNSPECIFIEDUNSPECIFIED
Date : 15 September 2011
Identification Number : 10.4088/PCC.11m01148
Related URLs :
Additional Information : This is an electronic version of an article published as Link CL, Stern TA, Piccolo RS, Marceau LD, Arber S, Adams A, Siegrist J, von dem Knesebeck O, McKinlay JB (2011). Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment. Primary Care Companion CNS Disord 13(5). Available online at: http://www.psychiatrist.com/pcc/tocs/tocs.asp?toc=c1305
Depositing User : Symplectic Elements
Date Deposited : 31 Jan 2013 10:41
Last Modified : 23 Sep 2013 19:18
URI: http://epubs.surrey.ac.uk/id/eprint/293560

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