Diagnosis delay in first episodes of major depression: a study of primary care patients in Spain

Background: Diagnosis delay may negatively influence the clinical course of major depression; however, few studies have analysed the role of environmental factors on diagnosis delay. This study was aimed to identify personal and environmental factors related to a longer delay.

Methods: A cross-sectional observational study with 3615 primary care patients with a first diagnosis of major depression was conducted. Diagnosis delay was defined as the time between onset of symptoms and diagnosis of major depression.

Results: Mean of delay was 9.89 weeks. Lower years of education, triggering stressful life events before the current episode, history of previous undiagnosed depressive episodes and somatic comorbidity were related to longer delay. Health system variables, such as urban setting, public health care setting, younger doctors and female doctors were also related to a longer delay.

Limitations: Onset of first depressive symptoms was retrospectively collected. The cross-sectional design does not allow making inferences about the temporal ordering between predictors and outcomes.

Conclusions: Both personal and environmental variables were related to diagnosis delay. Identification of these factors helps to design early diagnosis programs to ultimate reduce the morbidity associated with major depression.