Diagnosis and Management of Depression in Three Countries: Results from a Clinical Vignette Factorial Experiment

Abstract Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a "patient," with exactly the same symptoms indicative of depression, in three different health care systems (Germany, the United Kingdom, and the United States). Method: A factorial experiment was conducted in which 384 randomly selected primary care physicians viewed a video vignette of a "patient" presenting with symptoms suggestive of depression. Results: Most physicians listed depression as one of their diagnoses, but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (p=.0251). American physicians were almost twice as likely to prescribe an anti-depressant (p=.0241) as British physicians. German physicians were significantly more likely to refer the patient to a mental health professional (p<.0001) than British or American physicians. German physicians wanted to see the patient in follow-up sooner (p<.0001) than British or American physicians. Conclusions: Primary care physicians in different countries diagnose exactly same symptoms of depression differently, depending on the patient's gender. There are also significant differences between countries in the management of a "patient" with symptoms suggestive of depression. International differences in prevalence rates for 3 depression, and perhaps other diseases, may in part result from differences among health care systems in different countries