1. International Congress of the
Royal College of Psychiatrists
21-24 June 2010, EICC, Edinburgh
Recognition of Depression in Primary Care and Hospital Settings by
Nursing Staff – A Meta-analysis of Clinical Accuracy
Alex J Mitchell Consultant in Psychiatry, Department of Cancer & Molecular Medicine, University Hospitals Leicester (UK) ajm80@le.ac.uk
Venkatraghavan Kakkadasam LAS ST4 in General Adult Psychiatry, St Charles Mental Health Unit, Exmoor Street, London
vkakkadramaswamy@nhs.net
AIMS
To clarify the ability of nurses working in primary care and hospital settings to identify depressed individuals using their own
clinical skills.
BACKGROUND REVIEW
There is uncertainty regarding how well nurses identify patients with significant depression. Our group previously documented
that’s GPs have a sensitivity of 47.3% and specificity of 81.3% (Lancet. 2009 374(9690):609-19).
METHODS Meta-analysis of clinical accuracy against a continuum (severity scale) or categorically (semi-structured interview)..
RESULTS We located 4 studies involving primary care or community nurses and 7 involving hospital nurses. The prevalence of
depression was 27.9% (95% CI = 13.7% to 44.8%) in primary care/community studies and 27.1 (95% CI = 17.5% to 37.9%) in
hospital care.
On meta-analysis, practice and community nurses correctly identified 26.3% (95% CI = 16.2% to 37.8%) of people with depression.
They also correctly identified 94.8% (95% CI = 91.3% to 97.4%) of the non-depressed.
Nurses working in hospital settings correctly identified 43.1% (95% CI = 31.9% to 54.8%) of people with depression and 79.6% (95%
CI = 71.5% to 86.7%) of the non-depressed. By way of comparison from 19 studies involving general practitioners, their case-
finding area under the curve for was AUC = 0.650 (0.644 to 0.657) which was significantly lower than practice nurses (AUCpc =
0.7485; 0.726 to 0.770) but with no difference in the rule-out (screening) ability between groups.
Fig. Plot of Conditional Probability – Comparing Nursing Staff
1.00
Post-test Probability
0.90
0.80
0.70
0.60
NH NAs+
0.50
NH NAs-
0.40 Baseline Probability
HospN+
0.30 HospN-
PCC Nurses+
0.20
PCC Nurses-
0.10
Pre-test Probability
0.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
CONCLUSIONS Nurses have considerable difficulty accurately identifying depression but are probably at least as accurate as
medical staff. Nurses might benefit from simple screening strategies to aid with the detection of depression.
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