Increased Recognition of Depression in Primary Care

120

Background: Patients with persistent medically unexplained symptoms often exhibit general dysfunction and psychiatric comorbidity and frequently resist psychiatric referral. The aim of this study was to evaluate the efficacy of a collaborative care model including training for general practitioners (GPs) and a psychiatric consultation model for patients with persistent medically unexplained symptoms in general practice. Method: Randomised controlled trial. Cluster randomisation at GP practices and multilevel analysis were performed. A total of 81 patients from 36 general practices completed the study. A collaborative care model of training and psychiatric consultation in general practice in the presence of the GP was compared with training plus care as usual by the GP. Outcome assessment on the patients’ well-being, functioning and utilisation of health care services was performed 6 weeks and 6 months later. Results: All the patients had somatoform disorders (Whitely Index 7.46), and 86% had comorbid psychiatric disorders. In the intervention group, the severity of the main medically unexplained symptoms decreased by 58%. The patients’ social functioning improved. The utilization of health care was lower than in the care as usual group. Conclusions: A collaborative care model combining training with psychiatric consultation in the general practice setting is an effective intervention in the treatment of persistent medically unexplained symptoms. Anxiety and depressive disorders are highly comorbid in this group. The findings warrant a larger study.

Section: Discussionsupporting

confidence: 48%

Randomised Controlled Trial of a Collaborative Care Model with Psychiatric Consultation for Persistent Medically Unexplained Symptoms in General Practice

Feltz-Cornelis

Oppen²,

Adèr

et al. 2006

120

“…General medical providers typically see patients with less severe mental health problems and are more likely to prescribe antidepressants for these patients [39, 40]. However, in the multivariate analyses reported here, entering the interaction term of having seen a psychiatrist in the past year with time was not statistically significant and did not explain away the interaction term of psychopathology with time.…”

Section: Discussionmentioning

confidence: 65%

Increase in Antidepressant Medication in the US Adult Population between 1990 and 2003

Mojtabai¹

2008

Background: The rate of antidepressant treatment in the US has significantly increased in the past decade. There are, however, concerns about undertreatment among traditionally underserved groups and overtreatment in less severely ill individuals. This study examines trends in the prevalence of antidepressant drug treatment in two US general population surveys. Methods: The prevalence of antidepressant treatment within a 12-month period was compared in the US National Comorbidity Survey (1990–1992) and the National Comorbidity Survey-Replication (2001–2003). Variations in trends across groups were examined using bivariate and multivariate logistic regression models. Results: The rate of antidepressant drug treatment increased more than four times between early 1990s and early 2000s. The trend was similar across sociodemographic groups. Younger adults, men and racial/ethnic minorities continued to receive antidepressant treatment at a lower rate compared to middle-aged adults, women and non-Hispanic whites, respectively. The rate of antidepressant treatment increased more in the group of less severely ill individuals than in those with more severe psychopathology. Conclusions: Sociodemographic disparities in antidepressant treatment persisted over the last decade in the US, lending support to concerns about undertreatment among traditionally underserved groups, whereas the greater increase in the rate of antidepressant treatment in the less severely ill group lends support to concerns about antidepressant overtreatment in this population.

“…Less research attention has focused on the problem of overdiagnosis and overtreatment of depression, which is at least as common as underdiagnosis and undertreatment [2]. A study that compared Italian primary care physicians' clinical diagnoses with diagnoses based on the WHO ICD-10 found that 45% of patients labeled as depressed by primary care physicians did not meet the ICD-10 criteria [13]. Almost 30% of these patients diagnosed in 1996 were prescribed an antidepressant.…”

Section: Introductionmentioning

confidence: 99%

Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses

Mojtabai

2013

Background: Relatively little is known about the prevalence and correlates of overdiagnosis of depression in community settings. This study examined the extent to which individuals with clinician-identified depression in the community meet the criteria for DSM-IV major depressive episodes (MDE) and characteristics of these individuals. Methods: In a sample of 5,639 participants with clinician-identified depression drawn from the 2009-2010 United States National Survey of Drug Use and Health, the proportion of participants who met the 12-month MDE criteria, ascertained by a structured interview, and variations in MDE diagnosis across different groups of participants were examined. Mental health profiles and service use of participants who met the MDE criteria were compared to those who did not meet these criteria. Results: Only 38.4% of participants with 12-month clinician-identified depression met the 12-month MDE criteria. Older adults were less likely than younger adults to meet the criteria - only 14.3% of those 65 years old or older met the criteria, whereas participants with more education and those with poorer overall health were more likely to meet the criteria. Participants who did not meet the 12-month MDE criteria reported less distress and impairment in role functioning and used fewer services. A majority of both groups, however, were prescribed and used psychiatric medications. Conclusions: Depression overdiagnosis and overtreatment is common in community settings in the USA. There is a need for improved targeting of diagnosis and treatments of depression and other mental disorders in these settings.