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June 26, 1996

Treatment of Chronic Depression

Author Affiliations

New York State Psychiatric Institute New York, NY
Uniformed Services University of the Health Sciences Bethesda, Md
University of Wisconsin Medical School Madison
Albert Einstein College of Medicine Bronx, NY
University of South Alabama College of Medicine Mobile
Mercy Catholic Medical Center Darby, Pa

JAMA. 1996;275(24):1884. doi:10.1001/jama.1996.03530480025033

To the Editor.  —The discussion by Dr Goodwin1 of procedures for diagnosing depression states: "Although not used to establish the diagnosis, self-administered screening instruments, such as the General Health Questionnaire (with its subscale for depression), the Beck Depression Inventory, the Zung Self-rating Scale, and the PRIME-MD screening test, can be valuable aids in finding patients who require a more thorough diagnostic evaluation.... Although these screening instruments are sensitive (few false negatives), they are not specific (many false positives)." Although 1 component of PRIME-MD is a 1-page screening procedure, patients who are screened positive are then evaluated by the physician with a brief structured diagnostic interview. Thus, unlike the screening procedures mentioned by Goodwin, PRIME-MD is a diagnostic procedure. Furthermore, in the PRIME-MD 1000 study2 using the psychiatric diagnoses of mental health professionals who made blind interviews of patients as the criterion standard, diagnoses made by primary care physicians