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Depressive disorders in primary care: prevalence, functional disability, and identification
Williams JW, Kerber CA, Mulrow CD, Medina A, Aguilar C.. Journal of general internal medicine, 1995-01-01
Topic: Risk, prevention and care in population studies
Objectives To assess the relative prevalence of subsyndromal depression (SubD) and major depression (MDD) in primary care patients and describe their associated functional impairments, and to define the operating characteristics of a short depression screen (SDS). Setting Three primary care clinics: a university-affiliated Veterans Affairs clinic, a county general internal medicine clinic, and a community health center. Subjects Randomly selected adult patients (n = 221), aged > or = 30 years, with no history of psychiatric comorbidity, current substance abuse, major depressive disorder, chronic pain disorder, or dementia. Measurements The SDS and the Medical Outcomes Study Short Form 36 (SF-36) were interviewer-administered by an experienced bilingual research assistant to all subjects in the language of their choice. A physician administered independently the Structured Clinical Interview for DSM-III diagnosis (SCID) and the Hamilton Depression Rating Scale (HDRS) to all patients who exceeded a minimum threshold on the SDS and to a randomly selected sample of patients who had subthreshold scores. MDD was defined by DSM-III criteria and SubD was defined as two to four DSM-III criteria, of which one had to be depressed mood or anhedonia. Results Demographic and clinical characteristics of the patients were: Mexican American 53%, non-Hispanic white 38%, and African American 9%; men 68%; mean age 60 +/- 12.7 years; mean level of education 9.5 +/- 4.4 years; and hypertension 57%, diabetes mellitus 51%, and arthritis 45%. The prevalences of MDD and SubD (adjusted for sampling strategy) were 4% and 16%, respectively. For the patients who had MDD, the median HDRS score was 17 (interquartile range, 10-18), and for those who had SubD, the median HDRS score was 9 (interquartile range, 8-14). Compared with the patients who did not have depressive symptoms, those who had either MDD or SubD were significantly impaired in multiple domains of self-reported function. The sensitivity and specificity of the SDS for MDD were 100% (95% CI 57-100) and 72% (95% CI 63-81), respectively. For depressive disorders (MDD or SubD), the sensitivity was 66% (95% CI 49-83) and the specificity was 79% (95% CI 69-89). Conclusions SubD was more prevalent than MDD in these primary care settings. Both MDD and SubD were associated with significant functional impairment. The sensitivity of the SDS was lower for identifying depressive disorders (MDD or SubD) than it was for identifying MD.
Key findings
- Results Demographic and clinical characteristics of the patients were: Mexican American 53%, non-Hispanic white 38%, and African American 9%; men 68%; mean age 60 +/- 12.7 years; mean level of education 9.5 +/- 4.4 years; and hypertension 57%, diabetes mellitus 51%, and arthritis 45%.
- Compared with the patients who did not have depressive symptoms, those who had either MDD or SubD were significantly impaired in multiple domains of self-reported function.
- Both MDD and SubD were associated with significant functional impairment.
Why it matters
This primary care study found that both major depression and subsyndromal depression were common and linked to functional impairment, and it assessed a short depression screen. It concerns depression in primary care and does not test a treatment, cure or prevention for Alzheimer's disease.
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Study details
- Participants221
- Evidence strengthLow
How this study scored 55/100
Published in a peer-reviewed journal, and it is a randomised controlled trial. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of general internal medicine) |
| Journal's citation record | 3 / 4 | Journal of General Internal Medicine: journal h-index 283 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A randomised controlled trial (from PubMed type “Randomized Controlled Trial”) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1995 — older than 20 years, still counted |
| Sample size | 2 / 4 | 221 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 5 / 7 | Cited 146 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 4.4 citations a year over 33 year(s) since 1995 |
| Impact for its field and year | 4 / 6 | Cited 8.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Christine Aguilar: h-index 25 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Audie L. Murphy Memorial VA Hospital: institution h-index 243 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 7699487) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 55 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Williams, J. W., Kerber, C. A., Mulrow, C. D., Medina, A., & Aguilar, C. (1995). Depressive disorders in primary care: prevalence, functional disability, and identification. Journal of general internal medicine. https://doi.org/10.1007/bf02599568
Vancouver
Williams JW, Kerber CA, Mulrow CD, Medina A, Aguilar C. Depressive disorders in primary care: prevalence, functional disability, and identification. Journal of general internal medicine. 1995. doi:10.1007/bf02599568. PMID: 7699487.
BibTeX
@article{williams1995-7699487,
author = {Williams, J. W. and Kerber, C. A. and Mulrow, C. D. and Medina, A. and Aguilar, C.},
title = {{Depressive disorders in primary care: prevalence, functional disability, and identification}},
journal = {Journal of general internal medicine},
year = {1995},
doi = {10.1007/bf02599568},
pmid = {7699487},
url = {https://doi.org/10.1007/bf02599568}
}
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