Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study

Ormel, Johan; Brink, Wim van den; Koeter, Maarten W. J.; Giel, R; Meer, Klaas van der; Willige, G van de; Wilmink, F. W.

doi:10.1017/s0033291700036606

Cited by 251 publications

(142 citation statements)

References 29 publications

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“…There were four studies from Australia, [42][43][44][45] four from Italy, [46][47][48][49] six from the Netherlands, [50][51][52][53][54][55] three from the UK, [56][57][58] and eight from the US, [59][60][61][62][63][64][65][66] all reporting diagnostic sensitivity (Table 1).…”

Section: Study Description and Methodsmentioning

confidence: 99%

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Mitchell¹,

Rao²,

Vaze³

2011

Br J Gen Pract

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A meta-analysis of unassisted clinical diagnoses against semi-structured interviews. MethodA systematic literature search, critical appraisal, and pooled analysis were conducted and 25 international studies were identified involving 8917 individuals. A minimum of three independent studies per country were required to aid extrapolation. ResultsClinicians in the Netherlands performed best at case finding (the ability to rule in cases of depression with minimal false positives) (AUC+ 0.735) and this was statistically significantly better than the ability of clinicians in Australia (AUC+ 0.622) and the US (AUC+ 0.653), who were the worst performers. Clinicians from Italy had intermediate case-finding abilities. Regarding screening (the ability to rule out cases of no depression with minimal false negatives) there were no strong differences. Looking at overall accuracy, primary care physicians in Italy and the Netherlands were most successful in their diagnoses and physicians from the US and Australia least successful (83.5%, 81.9%, 74.3%, and 67.0%, respectively). GPs in the UK appeared to have the lowest ability to detect depression, as a proportion of all cases of depression (45.6%; 95% CI = 27.7% to 64.2%). Several factors influenced detection accuracy including: collecting data on clinical outcomes; routinely comparing the clinical performance of staff; working in small practices; and having long waits to see a specialist. ConclusionAssuming these differences are representative, there appear to be international variations in the ability of primary care physicians to diagnose depression, but little differences in screening success. These might be explained by organisational factors.

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Section: Study Description and Methodsmentioning

confidence: 99%

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Mitchell¹,

Rao²,

Vaze³

2011

Br J Gen Pract

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“…In contrast, the co-occurrence of MDD and anxiety has been found to facilitate recognition of depression (Coyne et al 1995) or psychiatric caseness (Ormel et al 1990 ;Sartorius et al 1996 ;Pini et al 1997Pini et al , 1999. However, these studies examined the effects of psychiatric and somatic co-morbidity on underdiagnosis of depression separately, and did not address their combined effect at all.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity

et al. 2005

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Background. Depression is highly co-morbid with both psychiatric and chronic somatic disease. These types of co-morbidity have been shown to exert opposite effects on underdiagnosis of depression by general practitioners (GPs). However, past research has not addressed their combined effect on underdiagnosis of depression.Method. Co-morbidity data on 191 depressed primary-care patients selected by a two-stage sampling procedure were analysed. Diagnoses of major depression and/or dysthymia in the last 12 months were assessed using a standardized psychiatric interview (CIDI) and compared with depression diagnoses registered by GPs in patient contacts during the same period. Presence of psychiatric and chronic somatic co-morbidity was determined using the CIDI and contact registration, respectively.Results. Regression analysis showed a significant interaction effect between psychiatric and chronic somatic co-morbidity on GPs’ diagnosis of depression, while taking into account the effects of sociodemographic variables, depression severity and number of GP contacts. Subsequent stratified analysis revealed that in patients without chronic somatic co-morbidity, a lower educational level, a less severe depression, and fewer GP contacts all significantly increased the likelihood of not being diagnosed as depressed. In contrast, in patients with chronic somatic co-morbidity, only having no psychiatric co-morbidity significantly decreased the likelihood of receiving a depression diagnosis.Conclusions. Our results indicate that the effects of psychiatric co-morbidity and other factors on underdiagnosis of depression by GPs differ between depressed patients with and without chronic somatic co-morbidity. Efforts to improve depression diagnosis by GPs seem to require different strategies for depressed patients with and without chronic somatic co-morbidity.

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“…Despite the availability of several treatment options with similar effectiveness in clinical trials, underrecognition and suboptimal treatment are common. [11][12][13][14] With conditions like depression, for which several viable treatment options exist, patient attitudes and preferences are important and may have a large impact on patient adherence and subsequent recovery. Few studies have incorporated patient perspectives in attempts to understand why certain patients drop out of treatment involving medications and counseling or fail to follow through on mental health referrals.…”

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confidence: 99%

Identification of patient attitudes and preferences regarding treatment of depression

et al. 1997

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OBJECTIVES:To identify attitudes that influence patient help-seeking behavior and aspects of treatment that influence patient preferences for management of depression. DESIGN:Three focus group discussions (two patient groups stratified by race and one professional group). Questions addressed experience with depression, help-seeking behaviors, treatment preferences, and perceived barriers to mental health care. SETTING: Academic medical center. PATIENTS/PARTICIPANTS:Eight black patients and eight white patients with depression; seven health care professionals (four physicians and three social workers). MEASUREMENTS AND MAIN RESULTS:Discussions were audiotaped, transcribed, and reviewed independently by two investigators to identify and group distinct comments into categories with specific themes. Differences were adjudicated by a third investigator. Comments within categories were then checked for relevance and consistency by a health services researcher and a psychiatrist. More than 90% of the 806 comments could be grouped into one of 16 categories. Black patients raised more concerns than white patients regarding spirituality and stigma. Patients made more comments than professionals regarding the impact of spirituality, social support systems, coping strategies, life experiences, patientprovider relationships, and attributes of specific treatments. They discussed the role these factors played in their helpseeking behavior and adherence to treatment. epression is one of the most common major mental disorders, affecting approximately 5% of the general population, mostly young adults and women, in any one year. 1 Depressive disorders have a substantial effect on the individual, the family, and society and are associated with more functional disability than most chronic medical illnesses. 2,3 Individuals with depression utilize health care services in the general medical and mental health sector three times as often as nondepressed controls, even after controlling for medical comorbidity. 4 The majority of individuals with depression in the United States who seek care receive all or part of their CONCLUSIONS:

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Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study

Cited by 251 publications

References 29 publications

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity

Identification of patient attitudes and preferences regarding treatment of depression

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