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Academic psychiatry's responsibility for increasing the recognition of mood disorders and risk for suicide in primary care

Lake, Charles Ra; Baumer, Joanieb

Current Opinion in Psychiatry: March 2010 - Volume 23 - Issue 2 - p 157–166
doi: 10.1097/YCO.0b013e328333e195
Special commentary

Purpose of review The authors seek solutions to better meet the healthcare needs of depressed patients in primary care by improving the recognition of depression, other mood disorders and of a risk for suicide.

Recent findings For 25 years academic psychiatry and primary care have known that only 10–50% of depressed patients are adequately treated, primarily because of the failure to recognize depression. There are substantial negative consequences including suicide. Suicide occurs during depression so the recognition of depression is the critical first step to preventing suicide. Recently noted is that one barrier to recognition is the traditional, comprehensive, psychiatric interview taught in academic departments of psychiatry that is impractical in primary care settings because it takes too much time. Some brief, initial psychiatric techniques have been developed but these typically have been introduced in primary care training programs and not by departments of psychiatry.

Summary A verbal four-question, 90 s screen for depression may be acceptable for routine use in primary care because it typically requires only seconds to a few minutes. Introduction of such a screening instrument to medical students on psychiatry and primary care clerkships could increase the recognition of depression and reduce death by suicide.

aDepartment of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, Kansas, USA

bDepartment of Family Medicine, John Peter Smith Hospital, Fort Worth, Texas, USA

Correspondence to C. Raymond Lake, MD, PhD, Professor, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160-7341, USA Tel: +1 816 678 4848; fax: +1 913 588 1310; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.