False positives, false negatives, and the validity of the diagnosis of XXXX in primary care.

@entity1 @entity308 @entity66 @entity146 @entity73
OBJECTIVE: To explore the issues of diagnostic specificity and @entity146 "caseness" (i.e., whether a @entity1 meets the conditions to qualify as a "case" of a @entity66 ) for @entity308 in the primary care setting. DESIGN: A cross-sectional study comparing the demographic, clinical, and mental health characteristics of @entity1 identified as @entity308 by their family physicians with those meeting diagnostic criteria for @entity308 on the criterion standard Structured Clinical Interview for Diagnostic and Statistical Manual of @entity146 , Revised Third Edition. SETTING: The offices of 50 family physicians from private and academic practice in southeast Michigan. @entity1 : A total of 1580 consecutive adult @entity1 being seen for routine primary care services, from whom a weighted sample of 372 @entity1 completed a set of mental health screening and diagnostic instruments. MAIN OUTCOME MEASURES: @entity1 were assigned to 1 of 4 groups (true positive, false positive, false negative, and true negative) based on clinician identification and Structured Clinical Interview for Diagnostic and Statistical Manual of @entity146 , Revised Third Edition diagnosis. Differences between the 4 groups in demographic and clinical characteristics, scores on mental health instruments and mental health history were explored. RESULTS: Physician identification of @entity308 was strongly associated with increased familiarity with the @entity1 and the presence of suggestive clinical cues, such as history of or treatment for @entity308 , @entity1 distress, and presence of vegetative symptoms. @entity1 in the false-positive group displayed significantly higher levels of distress and impairment and were significantly more likely to have a history of mental health problems and treatment than were those in the true-negative group. The 2 "misidentified" groups, false positives and false negatives, were indistinguishable in their clinical characteristics ( @entity73 , or mental health history). Both groups' scores occupied the middle ground between true positives and true negatives on most clinical characteristics. Physicians appeared to discriminate between these 2 groups on the basis of their knowledge of the @entity1 's clinical history. CONCLUSIONS: Misidentification of @entity308 in primary care may be in part an artifact of the use of the @entity146 model of caseness in the primary care setting. Our results are most consistent with a chronic disease-based model of @entity308 , in which @entity1 classified as false positive and false negative occupy a clinical middle ground between clearly @entity308 and clearly nondepressed @entity1 . Family physicians appear to respond to meaningful clinical cues in assigning the diagnosis of @entity308 to these @entity73 @entity1 .
