{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T13:56:51Z","timestamp":1767707811077,"version":"build-2065373602"},"reference-count":37,"publisher":"CSIRO Publishing","issue":"2","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":5035,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,5,3]]},"abstract":"<jats:p>General practitioners (GPs) identify that depression can be difficult to diagnose in populations with high rates of alcohol and other drug (AOD) use. This is a particular concern with gay men who are a population known to engage in high rates of AOD use and who are vulnerable to depression. This paper uses data from 563 gay men and their GPs to describe concordance between assessments of major depression and, in particular, whether AOD use undermines concordance. Data were collected as part of a larger study of male patients and GPs at high HIV-caseload general practices in Australia. Concordance was measured by comparing patients\u2019 scores on the Patient Health Questionnaire-9 screening tool, which is based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria, and GPs\u2019 ratings of the likelihood of depression for each participant. We observed high concordance between GPs\u2019 assessments of major depression and patients\u2019 scores on the PHQ-9 (79% agreement), although our analysis also suggested that concordance was better when it related to cases in which there was no depression. The high concordance observed in our study did not appear to be undermined by gay male patients\u2019 AOD use, with the exception of frequent use of crystal methamphetamine. Here, men who reported frequent use of methamphetamine were significantly less likely to have concordant assessments (adjusted odds ratio 0.3, 95% CI 0.1\u20130.8). Overall, GPs appear to identify depression among many of their gay male patients. While GPs should be aware of the potential complications presented by frequent crystal methamphetamine use, other AOD use may have less impact on the diagnosis of depression.<\/jats:p>","DOI":"10.1071\/py11011","type":"journal-article","created":{"date-parts":[[2011,11,7]],"date-time":"2011-11-07T00:51:15Z","timestamp":1320627075000},"page":"116-122","source":"Crossref","is-referenced-by-count":1,"title":["Does drug and alcohol use undermine concordance between doctors\u2019 assessments of major depression and patients\u2019 scores on a screening tool for depression among gay men attending general practice?"],"prefix":"10.1071","volume":"18","author":[{"given":"Joanne","family":"Bryant","sequence":"first","affiliation":[{"name":"ANational Centre in HIV Social Research, The University of New South Wales, Sydney, NSW 2052, Australia."},{"name":"FCorresponding author. Email: j.bryant@unsw.edu.au"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christy E.","family":"Newman","sequence":"additional","affiliation":[{"name":"ANational Centre in HIV Social Research, The University of New South Wales, Sydney, NSW 2052, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Holt","sequence":"additional","affiliation":[{"name":"ANational Centre in HIV Social Research, The University of New South Wales, Sydney, NSW 2052, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana M.","family":"Paquette","sequence":"additional","affiliation":[{"name":"ANational Centre in HIV Social Research, The University of New South Wales, Sydney, NSW 2052, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Gray","sequence":"additional","affiliation":[{"name":"ANational Centre in HIV Social Research, The University of New South Wales, Sydney, NSW 2052, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Canavan","sequence":"additional","affiliation":[{"name":"BNational Association of People Living with HIV\/AIDS, PO Box 917, Sydney, NSW 2042, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah C.","family":"Saltman","sequence":"additional","affiliation":[{"name":"CSouthern Cross University, PO Box 157, Lismore, NSW 2480, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan C.","family":"Kippax","sequence":"additional","affiliation":[{"name":"DSocial Policy Research Centre, The University of New South Wales, Sydney, NSW 2052, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael R.","family":"Kidd","sequence":"additional","affiliation":[{"name":"EFaculty of Health Sciences, Flinders University, PO Box 2100, Adelaide, SA 5001, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2011,11,7]]},"reference":[{"issue":"3","key":"2025110219102262100_R1","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1093\/fampra\/cmi120","article-title":"The overdiagnosis of depression in non-depressed patients in primary care.","volume":"23","author":"Aragon\u00e8s","year":"2006","journal-title":"Family Practice"},{"issue":"6","key":"2025110219102262100_R2","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1046\/j.1525-1497.2003.20938.x","article-title":"Underdiagnosis of depression in HIV: who are we missing?","volume":"18","author":"Asch","year":"2003","journal-title":"Journal of General Internal Medicine"},{"key":"2025110219102262100_R3"},{"issue":"1","key":"2025110219102262100_R4","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/0163-8343(95)00089-5","article-title":"Overdiagnosis of depression in the general hospital.","volume":"18","author":"Boland","year":"1996","journal-title":"General Hospital Psychiatry"},{"key":"2025110219102262100_R5","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1176\/appi.ajp.158.5.725","article-title":"Meta-analysis of the relationship between HIV infection and risk for depressive disorders.","volume":"158","author":"Ciesla","year":"2001","journal-title":"The American Journal of Psychiatry"},{"issue":"8","key":"2025110219102262100_R6","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1111\/j.1360-0443.2004.00759.x","article-title":"Prevalence of non-medical drug use and dependence among homosexuality active men and women in the US population.","volume":"99","author":"Cochran","year":"2004","journal-title":"Addiction (Abingdon, England)"},{"key":"2025110219102262100_R7","first-page":"650","article-title":"Diagnosing depression in primary care using self-completed instruments: UK validation of the PHQ-9 and CORE-OM.","volume":"57","author":"Gilbody","year":"2007","journal-title":"The British Journal of General Practice"},{"issue":"8","key":"2025110219102262100_R8","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1503\/cmaj.070281","article-title":"Screening and case-finding instruments for depression: a meta-analysis.","volume":"178","author":"Gilbody","year":"2008","journal-title":"Canadian Medical Association Journal"},{"issue":"4","key":"2025110219102262100_R9","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1037\/0278-6133.27.4.455","article-title":"Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men.","volume":"27","author":"Hatzenbuehler","year":"2008","journal-title":"Health Psychology"},{"issue":"Suppl.","key":"2025110219102262100_R10","first-page":"S31","article-title":"Comorbidity of common mental disorders and alcohol or other substance misuse in Australian general practice.","volume":"175","author":"Hickie","year":"2001","journal-title":"The Medical Journal of Australia"},{"issue":"5","key":"2025110219102262100_R11","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s11606-009-1248-6","article-title":"Comorbid depression is associated with an increased risk of dementia diagnosis in patients with diabetes: a prospective cohort study.","volume":"25","author":"Katon","year":"2010","journal-title":"Journal of General Internal Medicine"},{"key":"2025110219102262100_R12","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/1471-244X-8-70","article-title":"A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people.","volume":"8","author":"King","year":"2008","journal-title":"BMC Psychiatry"},{"issue":"4","key":"2025110219102262100_R13","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1080\/09595239996293","article-title":"Non-prescription drug use by gay men in Sydney, Melbourne and Brisbane.","volume":"18","author":"Knox","year":"1999","journal-title":"Drug and Alcohol Review"},{"key":"2025110219102262100_R14","first-page":"167","article-title":"\u2018It\u2019s really a myriad of different signals, not just the textbook\u2019: the complexities of diagnosing depression in gay men in general practice.","volume":"5","author":"K\u00f6rner","year":"2008","journal-title":"Mental Health in Family Medicine"},{"key":"2025110219102262100_R15","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure.","volume":"16","author":"Kroenke","year":"2001","journal-title":"Journal of General Internal Medicine"},{"key":"2025110219102262100_R16","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1016\/j.addbeh.2008.04.009","article-title":"Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-aged men.","volume":"33","author":"Ledgerwood","year":"2008","journal-title":"Addictive Behaviors"},{"key":"2025110219102262100_R17","first-page":"79","article-title":"Rates of depression among men attending high HIV caseload general practices in Australia.","volume":"5","author":"Mao","year":"2008","journal-title":"Mental Health in Family Medicine"},{"key":"2025110219102262100_R18","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/j.1753-6405.2009.00344.x","article-title":"Social factors associated with Major Depressive Disorder in homosexually active, gay men attending general practices in urban Australia.","volume":"33","author":"Mao","year":"2009","journal-title":"Australian and New Zealand Journal of Public Health"},{"issue":"5","key":"2025110219102262100_R19","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1111\/j.1743-6109.2008.01160.x","article-title":"Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia.","volume":"6","author":"Mao","year":"2009","journal-title":"Journal of Sexual Medicine"},{"issue":"11","key":"2025110219102262100_R20","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.2105\/AJPH.91.11.1869","article-title":"Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States.","volume":"91","author":"Mays","year":"2001","journal-title":"American Journal of Public Health"},{"issue":"6","key":"2025110219102262100_R21","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.2105\/AJPH.2006.096826","article-title":"Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations.","volume":"98","author":"Meyer","year":"2008","journal-title":"American Journal of Public Health"},{"issue":"2","key":"2025110219102262100_R22","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1176\/appi.ajp.161.2.278","article-title":"Distress and depression in men who have sex with men: the Urban Men\u2019s Health Study.","volume":"161","author":"Mills","year":"2004","journal-title":"The American Journal of Psychiatry"},{"key":"2025110219102262100_R23","first-page":"144","article-title":"Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies.","volume":"57","author":"Mitchell","year":"2007","journal-title":"The British Journal of General Practice"},{"issue":"9690","key":"2025110219102262100_R24","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/S0140-6736(09)60879-5","article-title":"Clinical diagnosis of depression in primary care: a meta-analysis.","volume":"374","author":"Mitchell","year":"2009","journal-title":"Lancet"},{"issue":"4","key":"2025110219102262100_R25","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1111\/j.1447-0349.2008.00541.x","article-title":"Mental illness and substance use: an Australian perspective.","volume":"17","author":"Munro","year":"2008","journal-title":"International Journal of Mental Health Nursing"},{"key":"2025110219102262100_R26","first-page":"678","article-title":"GPs understanding of how depression affects gay and HIV positive men.","volume":"37","author":"Newman","year":"2008","journal-title":"Australian Family Physician"},{"issue":"9","key":"2025110219102262100_R27","first-page":"667","article-title":"Roles ascribed to general practitioners by gay men with depression.","volume":"39","author":"Newman","year":"2010","journal-title":"Australian Family Physician"},{"unstructured":"NHMRC (2001) Australian alcohol guidelines: health risks and benefits. Available at http:\/\/www.alcohol.gov.au\/internet\/alcohol\/publishing.nsf\/content\/guidelines [Verified 6 February 2009]","key":"2025110219102262100_R28"},{"issue":"8","key":"2025110219102262100_R29","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1017\/S0033291705004812","article-title":"Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity.","volume":"35","author":"Nuyen","year":"2005","journal-title":"Psychological Medicine"},{"issue":"7374","key":"2025110219102262100_R30","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1136\/bmj.325.7374.1195","article-title":"Cannabis use and mental health in young people: cohort study.","volume":"325","author":"Patton","year":"2002","journal-title":"British Medical Journal"},{"issue":"1","key":"2025110219102262100_R31","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1111\/j.1468-1293.2009.00741.x","article-title":"Depression in patients with HIV is under-diagnosed: a cross-sectional study in Denmark.","volume":"11","author":"Rodkjaer","year":"2010","journal-title":"HIV Medicine"},{"key":"2025110219102262100_R32","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/1471-2296-9-45","article-title":"Experiences in managing problematic crystal methamphetamine use and associated depression in gay men and HIV positive men: in-depth interviews with general practitioners in Sydney, Australia.","volume":"9","author":"Saltman","year":"2008","journal-title":"BMC Family Practice"},{"issue":"11","key":"2025110219102262100_R33","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1046\/j.1360-0443.2001.961115896.x","article-title":"Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men\u2019s Health Study.","volume":"96","author":"Stall","year":"2001","journal-title":"Addiction"},{"issue":"4","key":"2025110219102262100_R34","doi-asserted-by":"publisher","first-page":"167","DOI":"10.4088\/PCC.v07n0405","article-title":"The importance of somatic symptoms in depression in primary care.","volume":"7","author":"Tylee","year":"2005","journal-title":"Primary Care Companion to the Journal of Clinical Psychiatry"},{"issue":"5","key":"2025110219102262100_R35","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1007\/s00127-007-0190-3","article-title":"High prevalence of mental disorders and comorbidity in the Geneva gay men\u2019s health study.","volume":"42","author":"Wang","year":"2007","journal-title":"Social Psychiatry and Psychiatric Epidemiology"},{"key":"2025110219102262100_R36","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1001\/archpsyc.1991.01810260032005","article-title":"Multidisciplinary baseline assessment of homosexual men with and without the human immunodeficiency virus infection, II: standardized clinical assessment of current and lifetime psychopathology.","volume":"48","author":"Williams","year":"1991","journal-title":"Archives of General Psychiatry"},{"key":"2025110219102262100_R37","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.genhosppsych.2007.06.004","article-title":"Diagnostic accuracy of the mood module of the patient health questionnaire: a systematic review.","volume":"29","author":"Wittkampf","year":"2007","journal-title":"General Hospital Psychiatry"}],"container-title":["Australian Journal of Primary Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/py\/article-pdf\/18\/2\/116\/946368\/py11011.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/py\/article-pdf\/18\/2\/116\/946368\/py11011.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:10:30Z","timestamp":1762128630000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/py\/article\/18\/2\/116\/118757\/Does-drug-and-alcohol-use-undermine-concordance"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,11,7]]},"references-count":37,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2012,5,3]]}},"URL":"https:\/\/doi.org\/10.1071\/py11011","relation":{},"ISSN":["1448-7527","1836-7399"],"issn-type":[{"type":"print","value":"1448-7527"},{"type":"electronic","value":"1836-7399"}],"subject":[],"published":{"date-parts":[[2011,11,7]]}}}