Depression in primary care. Part 1: Screening and diagnosis

  • Zainab AM
  • XV Pereira
Keywords: Depression, primary care, diagnosis, screening


One of the commonest psychological problems that a clinician would encounter in primary care is depression. Theprevalence of depression is high in women, the elderly and those with underlying physical problems or during the postpartumperiod. The spectrum of clinical presentations is wide and somatic complaints are more common in primary care clinics.Depression may present as a primary disorder and co-morbidity with other psychological problems or physical illnessesis high. A good clinical interview is an important form of assessment and a quick screening of depression can be donewith the administration of proper rating scales, such as the Patient Health Questionnaire, Hamilton Depression RatingScale or Geriatric Depression Scale. Repeated use of the same scale in a patient would help the clinician to monitor theprogress objectively.


Kessler RC, Berflund P, Demler O, et al. The epidemiology of major depressive disorder. Results from the national co-morbidity replication (NCS-R). JAMA. 2003;289(23):3095-105.

Murphy JM, Laird NM, Monson RR, et al. A 40-year perspective on the prevalence of depression: the Stirling County Study. Arch Gen Psychiatry. 2000;57(3):209-15.

World Health Organization. Health topics: Depression. Available at:

Bland RC. Epidemiology of affective disorders: a review. Can J Psychiatry. 1997;42(4):367-77.

Son SE, Kirchner JT. Depression in children and adolescents. Am Fam Physician. 2000;62(10):2297-308, 2311-2.

Ministry of Health and Malaysian Psychiatric Association. A Consensus Statement on Management of Depression. 1999.

Sherina MS, Rampal L, Aini M, et al. The prevalence of depression among elderly in an urban area of Selangor, Malaysia. International Medical Journal. 2005;4(2).

Krishnaswamy S. Psychiatric problems among the elderly in Malaysia. Med J Malaysia. 1997;52(3):222-5.

Peveler R, Carson A, Rodin G. ABC of psychological medicine. Depression in medical patients. BMJ. 2002;325(7356):149-52.

Libiger J. Depression is frequent in primary care. WPA Bulletin on Depression. 2005;10(29):1-4.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Kirmayer LJ. Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry. 2001;62(Suppl 13):22-8.

Bisson JI, Sakhuja D. Adjustment disorders. Psychiatry. 2006;5(7):240-42.

Stewart JT. Why don’t physicians consider depression in the elderly? Age-related bias, atypical symptoms, and ineffective screening approaches may be at play. Postgrad Med. 2004;115(6):57-9.

Kubler-Ross E. On Death and Dying. New York: Simon and Schuster; 1997:123-4.

Periyakoil, VJ. Fast Facts and Concepts #43: Is it grief or depression? June, 2001. End of Life / Palliative Education Resource Centre. Available from:

Hirschfeld RM. The Comorbidity of major depression and anxiety disorders: recognition and management in primary care. Prim Care Companion J Clin Psychiatry. 2001;3(6):244-54.

Lopez-Ibor JJ. Clinical interview as the basic tool for the diagnosis of depression. WPA Bulletin on Depression. 1993;1(1):7.

Remick RA. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ. 2002;167(11):253-60.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.

Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-92.

Lam RW, Michalak EE, Swinson RP. Assessment Scales in Depression, Mania and Anxiety. London: Taylor & Francis; 2005.

Azah MNN, Shah MEM Juwita S, et al. Validation of the Malay version brief Patient Health Questionnaire (PHQ-9) among adults attending family medicine clinics. Int Med J (Japan). 2005;12(4):259-63.

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.

Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-83;17(1):37-49.

Teh EE, Hasanah CI. Validation of Malay version of Geriatric Depression Scale among elderly inpatients. 2004. Available from:

Pies R, Rogers D. The recognition and treatment of depression: A review for the primary care clinician. 2005. Available from:

Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis. 2005;2(1):A4.

How to Cite
AMZ., & PereiraX. (2007). Depression in primary care. Part 1: Screening and diagnosis. Malaysian Family Physician, 2(3), 7. Retrieved from
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