Depression in Primary Care: Current and Future Challenges

Abstract

Low detection rates and low treatment rates need to be addressed. Planned reassessment may improve detection rates when the FP is uncertain whether MDD is present, but further research is needed to determine why FPs frequently do not initiate treatment, even when MDD is detected. A caring, attentive FP who monitors depressed patients is likely to have considerable placebo effect. Greater focus on integrated, concurrent treatment for MDD and chronic physical diseases in the middle-aged and elderly is also required.

Depression in Primary Care: What More Do We Need to Know?

“…They suggest that the persistently low rates of detection, treatment, and follow-up found in primary care need addressing to improve treatment adherence and patient outcomes, and that newer evidencebased models of case management and collaborative care need to be adopted, integrating care for depression with that for physical diseases. 1 Alongside this very useful overview of the issues, Dr Linda Gask 2 reviews studies of educating FPs about the identification and treatment of depression, and points out that simple education has largely failed to change practice. She identifies perceived structural obstacles to change, including a relative lack of time and resources in primary care, but highlights a tendency among FPs to conceptualize depression as reactive or endogenous, with subsequent uncertainty about treating it in the face of adverse life events and difficulties.…”

“…2 This implies that FPs perceive limits to the medical model of depression inherent in the research described by Dr Craven and Dr Bland, 1 and the need to take social factors into account, but that they are uncertain about how to do so in practice.…”

Psychometric properties of the Swedish version of the Outcome Questionnaire-45 as administered by automated technique in a large sample of mental ill-health patients in Primary Health Care

“…Mental ill-health is common in Primary Health care, 25-30% of the patients having mental health problems and some of them are not getting the treatment they need 1,2,3 . It is important for clinicians to use reliable and validated instruments to make good decisions about the patient's treatment.…”

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

“…Other countries have also noted lack of basic services in their primary health care, such as a shortfall of mental health screening in Canada and Australia. 16,17 On one hand, these young PCPs were actively engaged in professional development and quality improvement of their clinics. On the other hand, use of services by patients remained poor at each CHC: despite serving 50,000 people, the centers had an average of only 41,000 patient contacts a year, and each physician saw a median of just 12.5 patients per day.…”