Multicenter study of gastroenterologists' ability to identify anxiety and depression in a new patient encounter and its impact on diagnosis

Aim: Although gastroenterologists are frequently exposed to psychopathology few data exist regarding their ability to accurately assess anxiety and depression or the impact of their perceptions of anxiety and depression on diagnostic decisions. The aims of this study were to determine gastroenterologists' ability to correctly identify anxiety and depression in patients with gastrointestinal symptoms and to determine whether gastroenterologist perceptions of anxiety and depression affected postvisit diagnosis. Methods: One hundred fifty-nine consecutive patients making their initial visit to 3 university outpatient clinics were evaluated by 38 gastroenterologists and completed Hospital Anxiety and Depression Scale. Gastroenterologists rated their perceptions of patient anxiety and depression on 100-mm visual analog scales and indicated whether they thought the patient was clinically anxious or depressed. On the basis of the gastroenterologists' postvisit diagnosis, patients were entered into functional gastrointestinal disorder (FGID; n = 28), symptom-based (SB) diagnosis (n = 45), or organic disease (OD; n = 86) groups. Results: Anxiety and depression were present in 40% and 20% of patients, respectively. Gastroenterologists' categorization of patients as having clinically significant anxiety and depression were poor with positive predictive values of 0.52 and 0.26, respectively. Patients perceived as anxious by their gastroenterologist were more than twice as likely to receive a FGID diagnosis. Conclusions: Anxiety and depression were prevalent in the study population yet gastroenterologists did not accurately detect these conditions. However, gastroenterologists were more than twice as likely to diagnose patients whom they perceived as anxious as having an FGID, highlighting a need for improved psychosocial assessment in clinical practice and education to diminish misattributions regarding FGID.