ABSTRACT
The problem of identification and treatment of depression in primary care patients is increasingly recognized as an important health care issue (Attkisson & Zich, 1990; Depression Guideline Panel, 1993a, 1993b; Eisenberg, 1992). Although primary care physicians are the main providers of treatment for depression (Shapiro et al., 1984), rates of undetected depression in primary care patients have been found to range as high as 60% (Schulberg & Burns, 1988; Spitzer et al., 1994). The Epidemiologic Catchment Area (ECA) study found 45% of patients diagnosed with an affective disorder had sought treatment from a primary care physician for a nonpsychiatric medical problem in the prior 6 months (Shapiro et al., 1984). Often these patients present with somatic symptoms suggestive of a medical condition while volunteering few psychological complaints (Kroenke, Jackson, & Chamberlin, 1997; Schulberg & Burns, 1988).
