We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Biases in the Laboratory Diagnosis of Depression in Medical Practice

Martin F. Shapiro, MD; Anthony F. Lehman, MD; Sheldon Greenfield, MD
Arch Intern Med. 1983;143(11):2085-2088. doi:10.1001/archinte.1983.00350110063017.
Text Size: A A A
Published online


• Several studies, conducted in psychiatric settings, have reported that the dexamethasone suppression test (ST) is useful in the diagnosis of endogenous depression. To determine whether the test has clinical utility in internal medicine practice, data were reviewed and reanalyzed from all studies that evaluated the dexamethasone ST in the diagnosis of depression. In these 11 studies, the mean positive predictive value reported for the test was 84%, reflecting high prevalence of disease (50%), sensitivity (43%), and specificity (92%) in those specialized populations studied. When estimates of the prevalence and severity of conditions associated with depressed mood seen in internal medicine were used, the sensitivity dropped to 30%, and the specificity to 85%. Assuming a prevalence of 20%, a figure based on available epidemiologic data, the predictive value for a positive test would be 33%, too low to have value in most clinical settings. Data from studies currently available do not support the use of dexamethasone ST in internal medicine practice. More generally, before any test is adopted in a general medical setting, it should be studied in that setting, or available data should be reanalyzed to correct for biases affecting prevalence, sensitivity, and specificity that may inflate the test's value.

(Arch Intern Med 1983;143:2085-2088)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.