To the Editor.
—As a primary care physician, I congratulate Johnson et al on their article, "Service Utilization and Social Morbidity Associated With Depressive Symptoms in the Community."1 Their careful documentation of the clinical importance of depressive symptoms demonstrates the inadequacy of current psychiatric labeling to identify the spectrum of mental health problems confronting primary care. It is simple common sense to recognize that depression occurs over a continuum rather than in dichotomy as implied by diagnostic labels. By imposing the diagnostic dichotomy, we discount the distress experienced by most primary care patients as trivial or unimportant and risk undervaluing sociocultural factors that don't fit into the biomedical model.2I question, however, labeling fewer depressive symptoms as "subclinical" depression, since this designation implies that the diagnosis is hidden, difficult to detect, or "without clinical manifestation."3 In fact, these patients are defined by symptoms that are easily elicited.
Frank SH. Depressive Symptoms in the Community. JAMA. 1992;268(2):199-200. doi:10.1001/jama.1992.03490020043024