1
|
Basta M, Micheli K, Simos P, Zaganas I, Panagiotakis S, Koutra K, Krasanaki C, Lionis C, Vgontzas A. Frequency and risk factors associated with depression in elderly visiting Primary Health Care (PHC) settings: Findings from the Cretan Aging Cohort. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
2
|
Abstract
Mental health disorders face less stigma today than in the past, yet they continue to be misdiagnosed and at times improperly treated. One account for this problem is that physicians rely exclusively on a verbal interview of patients for diagnosis. Because this diagnostic method is likely to be shaped by the way patients present their symptoms, it is critical that we examine whether and how patients' communication practices shape diagnostic and treatment outcomes. This study examines a sample of 14 encounters involving mental health-related symptoms from a dataset of adult primary care visits. Using conversation analytic methods, I show that when patients present mental health symptoms by simply describing the symptoms, primary care physicians exhibit a preference for providing a physical health diagnosis. Conversely, when patients provide a concrete link between their symptoms and the way the symptoms are disrupting their everyday lives, primary care physicians typically provide a mental health diagnosis.
Collapse
|
3
|
Zinc, but not paracetamol, prevents depressive-like behavior and sickness behavior, and inhibits interferon-gamma and astrogliosis in rats. Brain Behav Immun 2020; 87:489-497. [PMID: 32006614 DOI: 10.1016/j.bbi.2020.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/20/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022] Open
Abstract
Considering all mental and addictive disorders, depression is the most responsible for years of life lost due to premature mortality and disability. Antidepressant drugs have limited effectiveness. Depression can be triggered by immune/inflammatory factors. Zinc and paracetamol interfere with immune system and have demonstrated beneficial effects on depression treatment when administered concomitant with antidepressant drugs. The objective of this study was to test zinc and/or paracetamol as treatments of depressive-like behavior, sickness behavior, and anxiety in rats, as well as to understand the central and peripheral mechanisms involved. Sickness behavior and depressive-like behavior were induced in rats with repetitive lipopolysaccharide (LPS, 1 mg/kg for two consecutive days) administrations. Rats received zinc and/or paracetamol for three consecutive days. Sickness behavior (daily body weight and open field general activity); anxiety (light-dark test); depressive-like/antidepressant behavior (forced swim test); plasma corticosterone and interferon (IFN)-gamma levels; and glial fibrillary acidic protein (GFAP) and tyrosine hydroxylase (TH) brain expression were evaluated. LPS induced sickness behavior and depressive-like behavior, as well as elevated IFN-gamma levels and increased GFAP expression. Zinc prevented both behavioral and biochemical impairments. Paracetamol and zinc + paracetamol association induced only slight beneficial effects. Anxiety, corticosterone, and TH do not seem be related with depression and the other behavioral and neuroimmune changes. In conclusion, zinc treatment was beneficial for sickness behavior and depressive-like behavior without concomitant administration of antidepressants. IFN-gamma and GFAP were linked with the expression of sickness behavior and depressive-like behavior and were also involved with the antidepressant effects. Therefore, zinc, IFN-gamma, and GFAP pathways should be considered for depression treatment.
Collapse
|
4
|
Brooks SK, Dunn R, Amlôt R, Rubin GJ, Greenberg N. Protecting the psychological wellbeing of staff exposed to disaster or emergency at work: a qualitative study. BMC Psychol 2019; 7:78. [PMID: 31823824 PMCID: PMC6905092 DOI: 10.1186/s40359-019-0360-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Disasters are becoming more prevalent across the world and people are frequently exposed to them as part of their occupational groups. It is important for organisations to understand how best to support employees who have experienced a trauma such as a disaster. The purpose of this study was to explore employees’ perceptions of workplace support and help-seeking in the context of a disaster. Methods Forty employees in England took part in semi-structured interviews. Thematic analysis was used to extract recurring themes from the data. Results Participants reported both positive and negative psychological outcomes of experiencing a disaster or emergency at work. Most had little training in how to prepare for, and cope with, the psychological impact. They perceived stigma around mental health and treatment for psychological issues which often made them reluctant to seek help. Many reported that the psychological support available in the workplace was insufficient and tended to be reactive rather than proactive. Interpersonal relationships at work were viewed as being important sources of support, particularly support from managers. Participants suggested that psychosocial training in the workplace could be beneficial in providing education about mental health, encouraging supportive workplace relationships, and developing listening skills and empathy. Conclusions Organisations can take steps to reduce the psychological impact of disasters on employees. This could be done through provision of training workshops incorporating mental health education to reduce stigma, and team-building exercises to encourage supportive workplace relationships.
Collapse
Affiliation(s)
- Samantha K Brooks
- Department of Psychological Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK.
| | - Rebecca Dunn
- Department of Psychological Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - Richard Amlôt
- Public Health England, Emergency Response Department Science & Technology, Health Protection Directorate, Porton Down, Salisbury, Wilts, SP4 0JG, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| |
Collapse
|
5
|
Chew-Graham CA, Shepherd T, Burroughs H, Dixon K, Kessler D. The value of an embedded qualitative study in a trial of a second antidepressant for people who had not responded to one antidepressant: understanding the perspectives of patients and general practitioners. BMC FAMILY PRACTICE 2018; 19:197. [PMID: 30547766 PMCID: PMC6293563 DOI: 10.1186/s12875-018-0877-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. The number of prescriptions for antidepressants has risen dramatically in recent years yet up to 50% of patients who are treated for depression with antidepressants do not report feeling better as a result of treatment, and do not show the desired improvement on depression measures. We report a qualitative study embedded in a trial of second antidepressant for people who had not responded to one antidepressant, exploring the acceptability of a combination of antidepressants from the perspectives of both patients and practitioners, together with experiences of participating in a clinical trial. METHODS A qualitative study embedded in a randomized controlled trial investigating the effectiveness and cost-effectiveness of combining mirtazapine with Serotonin-Noradrenaline Reuptake Inhibitor (SNRI) or Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants versus SNRI or SSRI therapy alone (the MIR trial). 59 interviews were conducted with people who declined to participate in the trial, people who completed the study and people who withdrew from the intervention, and 16 general practitioners. RESULTS Across the data-sets, four main themes were identified: the hard work of managing depression, uncertainties over the value of a second antidepressant, help-seeking at a point of crisis, and attainment and maintenance of a hard-won equilibrium. CONCLUSIONS Exploring reasons for declining to participate in a trial of a second antidepressant in people who had not responded to one antidepressant suggests that people who are already taking one antidepressant may be reluctant to take a second, being wary of possible side-effects, but also being unconvinced of the logic behind such a combination. In addition, people describe being in a state of equilibrium and reluctant to make a change, reflecting that this equilibrium is 'hard-won' and they are unwilling to risk disturbing this. This makes some people reluctant to enrol in a clinical trial. Understanding a patient's view on medication is important for GPs when discussing antidepressants. TRIAL REGISTRATION MIR Trial Registration: ISRCTN 06653773 .
Collapse
Affiliation(s)
- Carolyn A. Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs ST5 5BG UK
| | - Thomas Shepherd
- Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs ST5 5BG UK
| | - Heather Burroughs
- Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs ST5 5BG UK
| | - Katie Dixon
- Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs ST5 5BG UK
| | - David Kessler
- Centre for Academic Primary Care, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
| |
Collapse
|
6
|
DemonicSalmon: Monitoring mental health and social interactions of college students using smartphones. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.smhl.2018.07.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
7
|
The Role of MAPK and Dopaminergic Synapse Signaling Pathways in Antidepressant Effect of Electroacupuncture Pretreatment in Chronic Restraint Stress Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:2357653. [PMID: 29234374 PMCID: PMC5664199 DOI: 10.1155/2017/2357653] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/17/2017] [Accepted: 08/03/2017] [Indexed: 12/21/2022]
Abstract
Acupuncture has demonstrated the function in ameliorating depressive-like behaviors via modulating PKA/CREB signaling pathway. To further confirm the antidepressant mechanism of EA on the mitogen-activated protein kinase (MAPK) and dopaminergic synapse signaling pathways, 4 target proteins were detected based on our previous iTRAQ analysis. Rats were randomly divided into control group, model group, and electroacupuncture (EA) group. Except for the control group, all rats were subjected to 28 days of chronic restraint stress (CRS) protocols to induce depression. In the EA group, EA pretreatment at Baihui (GV20) and Yintang (GV29) was performed daily (1 mA, 2 Hz, discontinuous wave, 20 minutes) prior to restraint. The antidepressant-like effect of EA was measured by body weight and open-field test. The protein levels of DAT, Th, Mapt, and Prkc in the hippocampus were examined by using Western blot. The results showed EA could ameliorate the depression-like behaviors and regulate the expression levels of Prkc and Mapt in CRS rats. The effect of EA on DAT and Th expression was minimal. These findings implied that EA pretreatment could alleviate depression through modulating MAPK signaling pathway. The role of EA on dopaminergic synapse signaling pathways needs to be further explored.
Collapse
|
8
|
Norton J, Engberink AO, Gandubert C, Ritchie K, Mann A, David M, Capdevielle D. Health Service Utilisation, Detection Rates by Family Practitioners, and Management of Patients with Common Mental Disorders in French Family Practice. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:521-530. [PMID: 28107037 PMCID: PMC5546665 DOI: 10.1177/0706743716686918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Provide up-to-date detection rates for common mental disorders (CMD) and examine patient service-use since the Preferred Doctor scheme was introduced to France in 2005, with patients encouraged to register with and consult a family practitioner (FP) of their choice. METHODS Study of 1133 consecutive patients consulting 38 FPs in the Montpellier region, replicating a study performed before the scheme. Patients in the waiting room completed the self-report Patient Health Questionnaire (PHQ) and Client Service-Receipt Inventory with questions on registration with a Preferred Doctor and doctor-shopping. CMD was defined as reaching PHQ criteria for depression, somatoform, panic or anxiety disorder. For each patient, FPs completed a questionnaire capturing psychiatric caseness. RESULTS 81.2% of patients were seeing their Preferred Doctor on the survey-day. Of those with a CMD, 52.6% were detected by the FP. This increased with CMD severity and comorbidity. Detected cases were more likely to be consulting their Preferred Doctor (84.7% versus 79.4% for non-detected cases, p = 0.05) rather than another FP. They declared more visits to psychiatrists (17.2% versus 6.7%, p = 0.002). There was no association with consultation frequency or doctor-shopping, which both declined between the two studies. CONCLUSION The CMD detection rate is relatively high, with no increase compared to our previous study, despite a decline in doctor-shopping. An explanation is the same high proportion of patients visiting their usual FP on the survey-day at both periods, suggesting a limited impact of the scheme on care continuity. FP action taken highlights the importance of improving detection for providing care to patients with CMDs.
Collapse
Affiliation(s)
- Joanna Norton
- 1 Inserm, U1061, University of Montpellier, Montpellier, France
| | | | | | - Karen Ritchie
- 1 Inserm, U1061, University of Montpellier, Montpellier, France.,3 Center for Clinical Brain Sciences, University of Edinburgh, UK
| | - Anthony Mann
- 4 Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Michel David
- 2 Department of General Practice, University of Montpellier, France
| | - Delphine Capdevielle
- 1 Inserm, U1061, University of Montpellier, Montpellier, France.,5 University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
| |
Collapse
|
9
|
Moraes MMT, Galvão MC, Cabral D, Coelho CP, Queiroz-Hazarbassanov N, Martins MFM, Bondan EF, Bernardi MM, Kirsten TB. Propentofylline Prevents Sickness Behavior and Depressive-Like Behavior Induced by Lipopolysaccharide in Rats via Neuroinflammatory Pathway. PLoS One 2017; 12:e0169446. [PMID: 28056040 PMCID: PMC5215944 DOI: 10.1371/journal.pone.0169446] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/16/2016] [Indexed: 01/03/2023] Open
Abstract
Recent studies have demonstrated the intimate relationship between depression and immune disturbances. Aware of the efficacy limits of existing antidepressant drugs and the potential anti-inflammatory properties of propentofylline, we sought to evaluate the use of propentofylline as a depression treatment. We used a rat model of depression induced by repetitive lipopolysaccharide (LPS) administrations. We have studied sickness behavior, by assessing daily body weight, open field behavior, and TNF-α plasmatic levels. Anxiety-like behavior (light-dark test), depressive-like behavior (forced swim test), plasmatic levels of the brain-derived neurotrophic factor (BDNF, depression biomarker), and central glial fibrillary acidic protein (GFAP) expression (an astrocyte biomarker) were also evaluated. LPS induced body weight loss, open field behavior impairments (decreased locomotion and rearing, and increased immobility), and increased TNF-α levels in rats, compared with control group. Thus, LPS induced sickness behavior. LPS also increased the immobility and reduced climbing in the forced swim test, when compared with the control group, i.e., LPS induced depressive-like behavior in rats. Propentofylline prevented sickness behavior after four days of consecutive treatment, as well as prevented the depressive-like behavior after five days of consecutive treatments. Propentofylline also prevented the increase in GFAP expression induced by LPS. Neither LPS nor propentofylline has influenced the anxiety and BDNF levels of rats. In conclusion, repetitive LPS administrations induced sickness behavior and depressive-like behavior in rats. Propentofylline prevented both sickness behavior and depressive-like behavior via neuroinflammatory pathway. The present findings may contribute to a better understanding and treatment of depression and associated diseases.
Collapse
Affiliation(s)
- Márcia M. T. Moraes
- Environmental and Experimental Pathology, Paulista University, Sao Paulo, Brazil
| | - Marcella C. Galvão
- Department of Pathology, School of Veterinary Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Danilo Cabral
- Environmental and Experimental Pathology, Paulista University, Sao Paulo, Brazil
| | - Cideli P. Coelho
- Graduate Program of Animal Medicine and Welfare, University of Santo Amaro, Sao Paulo, Brazil
| | | | - Maria F. M. Martins
- Environmental and Experimental Pathology, Paulista University, Sao Paulo, Brazil
| | - Eduardo F. Bondan
- Environmental and Experimental Pathology, Paulista University, Sao Paulo, Brazil
| | - Maria M. Bernardi
- Environmental and Experimental Pathology, Paulista University, Sao Paulo, Brazil
| | - Thiago Berti Kirsten
- Environmental and Experimental Pathology, Paulista University, Sao Paulo, Brazil
- Department of Pathology, School of Veterinary Medicine, University of São Paulo, Sao Paulo, Brazil
- * E-mail:
| |
Collapse
|
10
|
Explaining the variation between practices in the duration of new antidepressant treatment: a database cohort study in primary care. Br J Gen Pract 2016; 65:e114-20. [PMID: 25624307 DOI: 10.3399/bjgp15x683557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Practices vary in the duration of newly initiated antidepressant treatment, even after adjusting for patient characteristics. It was hypothesised that this may be because of differences between practices in demographic (practice deprivation and antidepressant prescribing rates), organisational (practice size and proportion of female GPs), and clinical factors (proportion of new episodes of depression coded). AIM To examine the effect of practice characteristics on the duration of new selective serotonin reuptake inhibitor antidepressant treatment in primary care. DESIGN AND SETTING Database cohort study of 28 027 patients from 237 GP practices in Scotland. METHOD Prescription data were used to estimate duration of treatment for individual patients beyond three time points: 30, 90, and 180 days. Data at patient and practice level were analysed by multilevel logistic regression to quantify the variation between practices. RESULTS The mean rate of diagnostic coding for depression in patients beginning a course of treatment was 29% (range 0-80%). Practice-level deprivation and rate of new antidepressant prescribing were not associated with duration of treatment. The practice level factor most strongly associated with duration of treatment at practice level was the proportion of patients coded as having depression: odds ratio for continuing beyond 30 days was 1.54 (95% confidence interval [CI] = 1.22 to 1.94); beyond 90 days, 1.37 (95% CI = 1.09 to 1.71); and beyond 180 days 1.41 (95% CI = 1.10 to 1.82). CONCLUSION Encouraging coding and structured follow-up at the onset of treatment of depression is likely to reduce early discontinuation of antidepressant treatment and improve outcomes.
Collapse
|
11
|
Vuorilehto MS, Melartin TK, Riihimäki K, Isometsä ET. Pharmacological and psychosocial treatment of depression in primary care: Low intensity and poor adherence and continuity. J Affect Disord 2016; 202:145-52. [PMID: 27262636 DOI: 10.1016/j.jad.2016.05.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary health care bears the main responsibility for treating depression in most countries. However, few studies have comprehensively investigated provision of pharmacological and psychosocial treatments, their continuity, or patient attitudes and adherence to treatment in primary care. METHODS In the Vantaa Primary Care Depression Study, 1111 consecutive primary care patients in the City of Vantaa, Finland, were screened for depression with Prime-MD, and 137 were diagnosed with DSM-IV depressive disorders via SCID-I/P and SCID-II interviews. The 100 patients with current major depressive disorder (MDD) or partly remitted MDD at baseline were prospectively followed up to 18 months, and their treatment contacts and the treatments provided were longitudinally followed. RESULTS The median number of patients' visits to a general practitioner during the follow-up was five; of those due to depression two. Antidepressant treatment was offered to 82% of patients, but only 50% commenced treatment and adhered to it adequately. Psychosocial support was offered to 49%, but only 29% adhered to the highly variable interventions. Attributed reasons for poor adherence varied, including negative attitude, side effects, practical obstacles, or no perceived need. About one-quarter (23%) of patients were referred to specialized care at some time-point. LIMITATIONS Moderate sample size. Data collected in 2002-2004. CONCLUSIONS The majority of depressive patients in primary health care had been offered pharmacotherapy, psychotherapeutic support, or both. However, effectiveness of these efforts may have been limited by lack of systematic follow-up and poor adherence to both pharmacotherapy and psychosocial treatment.
Collapse
Affiliation(s)
- Maria S Vuorilehto
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tarja K Melartin
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Riihimäki
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Health Care and Social Services, City of Järvenpää, Järvenpää, Finland
| | - Erkki T Isometsä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| |
Collapse
|
12
|
Hobden B, Bryant J, Sanson-Fisher R, Oldmeadow C, Carey M. Co-occurring depression and alcohol misuse is under-identified in general practice: A cross-sectional study. J Health Psychol 2016; 23:1085-1095. [DOI: 10.1177/1359105316643855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Depression and alcohol misuse are common co-occurring conditions. This study aimed to determine the accuracy of general practitioner identification of depression and alcohol misuse. Participants from 12 Australian general practices reported demographic and health risk behaviour data. General practitioners were asked to indicate the presence or absence of six health risk factors for individual patients. Accuracy of general practitioner identification was low at 21 per cent. Those with severe alcohol misuse, no chronic diseases and lower education levels were more likely to be identified. Routine screening prior to patient appointments may be a simple and efficient way to increase identification rates.
Collapse
|
13
|
Chin WY, Choi EPH, Wan EYF. Trajectory Pathways for Depressive Symptoms and Their Associated Factors in a Chinese Primary Care Cohort by Growth Mixture Modelling. PLoS One 2016; 11:e0147775. [PMID: 26829330 PMCID: PMC4734622 DOI: 10.1371/journal.pone.0147775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/07/2016] [Indexed: 01/30/2023] Open
Abstract
Background The naturalistic course for patients suffering from depressive disorders can be quite varied. Whilst some remit with little or no intervention, others may suffer a more prolonged course of symptoms. The aim of this study was to identify trajectory patterns for depressive symptoms in a Chinese primary care cohort and their associated factors. Methods and Results A 12-month cohort study was conducted. Patients recruited from 59 primary care clinics across Hong Kong were screened for depressive symptoms using the Centre for Epidemiologic Studies Depression Scale (CES-D) and monitored over 12 months using the Patient Health Questionnaire-9 items (PHQ-9) administered at 12, 26 and 52 weeks. 721 subjects were included for growth mixture modelling analysis. Using Akaike Information Criterion, Bayesian Information Criterion, Entropy and Lo-Mendell-Rubin adjusted likelihood ratio test, a seven-class trajectory path model was identified. Over 12 months, three trajectory groups showed improvement in depressive symptoms, three remained static, whilst one deteriorated. A mild severity of depressive symptoms with gradual improvement was the most prevalent trajectory identified. Multivariate, multinomial regression analysis was used to identify factors associated with each trajectory. Risk factors associated with chronicity included: female gender; not married; not in active employment; presence of multiple chronic disease co-morbidities; poor self-rated general health; and infrequent health service use. Conclusions Whilst many primary care patients may initially present with a similar severity of depressive symptoms, their course over 12 months can be quite heterogeneous. Although most primary care patients improve naturalistically over 12 months, many do not remit and it is important for doctors to be able to identify those who are at risk of chronicity. Regular follow-up and greater treatment attention is recommended for patients at risk of chronicity.
Collapse
Affiliation(s)
- Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F., 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong
- * E-mail:
| | - Edmond P. H. Choi
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block 21 Sassoon Road, Pokfulam, Hong Kong
| | - Eric Y. F. Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F., 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong
| |
Collapse
|
14
|
van den Bemt L, Luijks H, Bor H, Termeer E, Lucassen P, Schermer T. Are asthma patients at increased risk of clinical depression? A longitudinal cohort study. J Asthma 2015; 53:43-9. [PMID: 26313241 DOI: 10.3109/02770903.2015.1059852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this study, we assessed whether adult patients with asthma are more likely to be diagnosed with depression than diabetes patients or "healthy" controls during follow-up in primary care. METHODS Data from the Nijmegen Continuous Morbidity Registration were used to assess the risk for a first depression. Patients with asthma were compared with patients with diabetes and with two healthy controls matched on age, gender, socioeconomic status and attending general practice. With Cox proportional hazard analysis, we compared the risk of depression between these groups. These analyses were corrected for relevant covariates including a time-depending variable for multimorbidity. Explorative subgroup analyses were done for age, gender, socioeconomic status and multimorbidity. RESULTS Cumulative incidence of depression in asthma patients was 5.2%, in DM patients 4.1% and in control subjects 3.3%. The hazard ratios for a first episode of depression in the asthma patients (n = 795) compared to DM patients (n = 1033) and control subjects after correction for covariates were 1.11 (95% CI 0.60-2.04) and 1.18 (95% CI 0.78-1.79), respectively. Exploratory analyses showed that asthma patients without multimorbidity were at higher risk for a depression compared to reference groups, while asthma patients with multimorbidity were at lower risk for depression. CONCLUSION Asthma patients were not more likely to be diagnosed with a first depression compared to "healthy" control subjects or diabetes patients. The influence of multimorbidity on depression risk in asthma patients warrants further study.
Collapse
Affiliation(s)
- Lisette van den Bemt
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hilde Luijks
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hans Bor
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Evelien Termeer
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Peter Lucassen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tjard Schermer
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| |
Collapse
|
15
|
Argyropoulos K, Bartsokas C, Argyropoulou A, Gourzis P, Jelastopulu E. Depressive symptoms in late life in urban and semi-urban areas of South-West Greece: An undetected disorder? Indian J Psychiatry 2015; 57:295-300. [PMID: 26600585 PMCID: PMC4623650 DOI: 10.4103/0019-5545.166617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to estimate the prevalence and probable under-diagnosis of depressive symptoms in elderly of an urban and semi-urban area in Greece. MATERIALS AND METHODS A cross-sectional study was conducted among the members of 4 days care centers for older people (KAPI), three in the municipality of Patras, West-Greece, and in one in Tripolis, Peloponnese, Greece. A total of 378 individuals took part in the study, aged >60 years. A questionnaire was developed to collect basic demographic data, including three questions from the European Health Interview Survey, regarding self-reported or by a physician-diagnosed depression. Moreover, to all participants the Greek validated version of the Geriatric Depression Scale-15 (GDS-15) was applied, to screen for depressive symptoms. RESULTS According to GDS-15, 48.1% of the studied population screened positive for depressive symptoms (38.6% moderate, 9.5% severe), whereas having ever been affected with chronic depression reported 19.0% by themselves. In 162 members of KAPI of Patras and in 106 of Tripolis, who never reported have been affected by depression and depressive symptoms were observed in 27.7% and 44.7%, respectively. In 28 individuals from Patras, who reported not to know if they have depression and in 10 from Tripolis, depressive symptoms were observed in 60.7% and 90%, respectively, applying the GDS-15. CONCLUSION Except the high prevalence, the present study reveals a remarkable under-detection of depressive symptoms in older adults. Various interventions in primary care are necessary so as to increase detection rates of depression among the elderly.
Collapse
Affiliation(s)
- Konstantinos Argyropoulos
- Department of Public Health, School of Medicine, University of Patras, Greece ; Department of Psychiatry, Panarcadian General Hospital of Tripolis, Greece
| | - Christos Bartsokas
- Department of Public Health, School of Medicine, University of Patras, Greece
| | | | | | - Eleni Jelastopulu
- Department of Public Health, School of Medicine, University of Patras, Greece
| |
Collapse
|
16
|
Carey M, Yoong SL, Grady A, Bryant J, Jayakody A, Sanson-Fisher R, Inder KJ. Unassisted detection of depression by GPs: who is most likely to be misclassified? Fam Pract 2015; 32:282-7. [PMID: 25722482 DOI: 10.1093/fampra/cmu087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is important to examine patient and GP characteristics associated with misclassification so that systems can be improved to increase accurate detection and optimal management for groups at risk of depression. OBJECTIVE To examine patient and GP characteristics associated with GP misclassification of depression for patients classified by the Patient Health Questionnaire-9 as depressed. METHODS A cross-sectional study within general practices in two states of Australia. GPs completed a one-page paper and pencil survey indicating whether they thought each patient was clinically depressed. Patients completed a computer tablet survey while waiting for their appointment to provide demographic information and indicate depression status. Chi-square analyses were used to determine whether patient and GP characteristics were associated with a false-negative and false-positive result. The probability of misclassification was modelled using Generalized Estimating Equations to account for clustering of patients. RESULTS Fifty GPs from 12 practices participated. GPs completed surveys for 1880 patients. Younger patients aged 25-44, and those with a health care card were less likely to have a false-negative assessment. Patients with 0-3 GP visits in the past 12 months, and those with private health insurance were less likely to have a false-positive assessment. GPs who worked five sessions or fewer per week were more likely to make false-positive assessments.
Collapse
Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights,
| | | | - Alice Grady
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Amanda Jayakody
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Kerry J Inder
- Hunter Medical Research Institute, New Lambton Heights, NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia
| |
Collapse
|
17
|
Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 399] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
Collapse
Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
| | | |
Collapse
|
18
|
Menear M, Doré I, Cloutier AM, Perrier L, Roberge P, Duhoux A, Houle J, Fournier L. The influence of comorbid chronic physical conditions on depression recognition in primary care: a systematic review. J Psychosom Res 2015; 78:304-13. [PMID: 25676334 DOI: 10.1016/j.jpsychores.2014.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/14/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE People with depression often suffer from comorbid chronic physical conditions and such conditions are widely believed to interfere with primary care providers' ability to recognize their depression. We aimed to examine the evidence related to the influence of chronic physical comorbidity burden on depression recognition in routine, community-based primary care settings. METHODS We conducted a systematic review of the literature on depression recognition in primary care that featured comparisons between patient groups with higher and lower burdens of chronic physical comorbidity. Medline, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials were searched from inception to July 2013. Reference list and reverse citation searches were also performed. A narrative synthesis was conducted given clinical and methodological heterogeneity between studies. RESULTS Our search identified 5817 unique citations, out of which we identified 13 studies reporting data on the relationship between chronic physical comorbidity burden and depression recognition in primary care. Four studies provided some evidence that higher chronic physical comorbidity burden negatively affected primary care providers' ability to recognize depression. In contrast, two studies reported higher rates of recognition in patients with higher comorbidity burden and seven studies reported no differences in recognition between comorbidity groups. CONCLUSION Chronic physical comorbidity burden does not consistently affect depression recognition negatively in primary care. Instead, recognition seems to vary depending on the specific conditions or combination of conditions examined. Methodological choices of authors, such as approaches to measuring recognition and chronic medical comorbidity, also likely explain some divergent results across studies.
Collapse
Affiliation(s)
- Matthew Menear
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada
| | - Isabelle Doré
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada
| | | | - Laure Perrier
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Sherbrooke University, Canada
| | - Arnaud Duhoux
- School of Public Health, University of Montreal, Canada; Faculty of Nursing, University of Montreal, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Canada
| | - Louise Fournier
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada.
| |
Collapse
|
19
|
Poulsen KM, Pachana NA, McDermott BM. Health professionals' detection of depression and anxiety in their patients with diabetes: The influence of patient, illness and psychological factors. J Health Psychol 2014; 21:1566-75. [PMID: 25512198 DOI: 10.1177/1359105314559618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines how often depression and anxiety, in patients with diabetes, are detected by health professionals; and whether detection is influenced by patient characteristics (age, gender), illness factors (duration of illness, diabetes control), and self-reported levels of depression and anxiety. Prevalence rates of clinically significant depression and anxiety were high (57% and 36%, respectively); however, of those identified, only 44 and 36 per cent, respectively, were detected by staff as depressed or anxious. The only significant predictors of detection were severity of depressive and anxious symptoms. Patient and illness characteristics did not influence whether professionals identified emotional problems in their patients.
Collapse
Affiliation(s)
- Kellee M Poulsen
- Mater Child and Youth Mental Health Service, Brisbane, Australia
| | | | | |
Collapse
|
20
|
Schwarzbach M, Luppa M, Hansen H, König HH, Gensichen J, Petersen JJ, Schön G, Wiese B, Weyerer S, Bickel H, Fuchs A, Maier W, van den Bussche H, Scherer M, Riedel-Heller SG. A comparison of GP and GDS diagnosis of depression in late life among multimorbid patients - results of the MultiCare study. J Affect Disord 2014; 168:276-83. [PMID: 25080391 DOI: 10.1016/j.jad.2014.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective of the study was to compare General Practitioners׳ (GPs) diagnosis of depression and depression diagnosis according to Geriatric Depression Scale (GDS) and to identify potential factors associated with both depression diagnosis methods. METHODS The data were derived from the baseline wave of the German MultiCare1 study, which is a multicentre, prospective, observational cohort study of 3177 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Depressive symptoms were assessed with a short version of the Geriatric Depression Scale (15 items, cut-off 6). Cohen׳s kappa was used to assess agreement of GP and GDS diagnoses. To identify factors that might have influenced GP and GDS diagnoses of depression, binary logistic regression analyses were performed. RESULTS Depressive symptoms according to GDS were diagnosed in 12.6% of the multimorbid subjects, while 17.8% of the patients received a depression diagnosis by their GP. The agreement between general practitioners and GDS diagnosis was poor. To summarize we find that GPs and the GDS have different perspectives on depression. To GPs somatic and psychological comorbid conditions carry weight when diagnosing depression, while cognitive impairment in form of low verbal fluency, pain and comorbid somatic conditions are relevant for a depression diagnosis by GDS. CONCLUSIONS Each depression diagnosing method is influenced by different variables and therefore, has advantages and limitations. Possibly, the application of both, GP and GDS diagnoses of depression, could provide valuable support in combining the different perspectives of depression and contribute to a comprehensive view on multimorbid elderly in primary care setting.
Collapse
Affiliation(s)
- Michaela Schwarzbach
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Heike Hansen
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Gensichen
- Institute for General Practice, Friedrich-Schiller-University Hospital, Jena, Germany
| | - Juliana J Petersen
- Institute for General Practice, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | | | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, München, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | | |
Collapse
|
21
|
Isometsä E. Suicidal behaviour in mood disorders--who, when, and why? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:120-30. [PMID: 24881160 PMCID: PMC4079239 DOI: 10.1177/070674371405900303] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE About one-half to two-thirds of all suicides are by people who suffer from mood disorders; preventing suicides among those who suffer from them is thus central for suicide prevention. Understanding factors underlying suicide risk is necessary for rational preventive decisions. METHOD The literature on risk factors for completed and attempted suicide among subjects with depressive and bipolar disorders (BDs) was reviewed. RESULTS Lifetime risk of completed suicide among psychiatric patients with mood disorders is likely between 5% and 6%, with BDs, and possibly somewhat higher risk than patients with major depressive disorder. Longitudinal and psychological autopsy studies indicate suicidal acts usually take place during major depressive episodes (MDEs) or mixed illness episodes. Incidence of suicide attempts is about 20- to 40-fold, compared with euthymia, during these episodes, and duration of these high-risk states is therefore an important determinant of overall risk. Substance use and cluster B personality disorders also markedly increase risk of suicidal acts during mood episodes. Other major risk factors include hopelessness and presence of impulsive-aggressive traits. Both childhood adversity and recent adverse life events are likely to increase risk of suicide attempts, and suicidal acts are predicted by poor perceived social support. Understanding suicidal thinking and decision making is necessary for advancing treatment and prevention. CONCLUSION Among subjects with mood disorders, suicidal acts usually occur during MDEs or mixed episodes concurrent with comorbid disorders. Nevertheless, illness factors can only in part explain suicidal behaviour. Illness factors, difficulty controlling impulsive and aggressive responses, plus predisposing early exposures and life situations result in a process of suicidal thinking, planning, and acts.
Collapse
Affiliation(s)
- Erkki Isometsä
- Professor of Psychiatry, Department of Psychiatry, University of Helsinki, Helsinki, Finland; Research Professor, Department of Mental Health and Substance Use Services, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
22
|
Riihimäki K, Vuorilehto M, Melartin T, Haukka J, Isometsä E. Incidence and predictors of suicide attempts among primary-care patients with depressive disorders: a 5-year prospective study. Psychol Med 2014; 44:291-302. [PMID: 23570583 DOI: 10.1017/s0033291713000706] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND No previous study has prospectively investigated incidence and risk factors for suicide attempts among primary care patients with depression. METHOD In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients was screened for depression, and Structured Clinical Interviews for DSM-IV used to diagnose Axis I and II disorders. A total of 137 patients were diagnosed with a DSM-IV depressive disorder. Altogether, 82% of patients completed the 5-year follow-up. Information on timing of suicide attempts, plus major depressive episodes (MDEs) and partial or full remission, or periods of substance abuse were examined with life charts. Incidence of suicide attempts and their stable and time-varying risk factors (phases of depression/substance abuse) were investigated using Cox proportional hazard and Poisson regression models. RESULTS During the follow-up there were 22 discrete suicide attempts by 14/134 (10.4%) patients. The incidence rates were 0, 5.8 and 107 during full or partial remission or MDEs, or 22.2 and 142 per 1000 patient-years during no or active substance abuse, respectively. In Cox models, current MDE (hazard ratio 33.5, 95% confidence interval 3.6-309.7) was the only significant independent risk factor. Primary care doctors were rarely aware of the suicide attempts. CONCLUSIONS Of the primary care patients with depressive disorders, one-tenth attempted suicide in 5 years. However, risk of suicidal acts was almost exclusively confined to MDEs, with or without concurrent active substance abuse. Suicide prevention among primary care patients with depression should focus on active treatment of major depressive disorder and co-morbid substance use, and awareness of suicide risk.
Collapse
Affiliation(s)
- K Riihimäki
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
| | - M Vuorilehto
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
| | - T Melartin
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
| | - J Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Isometsä
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
| |
Collapse
|
23
|
Kendrick T. Depression in primary care: what more do we need to know? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:439-41. [PMID: 23972104 DOI: 10.1177/070674371305800801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tony Kendrick
- Professor of Primary Care, Primary and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, England
| |
Collapse
|
24
|
Gunn J, Elliott P, Densley K, Middleton A, Ambresin G, Dowrick C, Herrman H, Hegarty K, Gilchrist G, Griffiths F. A trajectory-based approach to understand the factors associated with persistent depressive symptoms in primary care. J Affect Disord 2013; 148:338-46. [PMID: 23375580 DOI: 10.1016/j.jad.2012.12.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/24/2012] [Accepted: 12/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depression screening in primary care yields high numbers. Knowledge of how depressive symptoms change over time is limited, making decisions about type, intensity, frequency and length of treatment and follow-up difficult. This study is aimed to identify depressive symptom trajectories and associated socio-demographic, co-morbidity, health service use and treatment factors to inform clinical care. METHODS 789 people scoring 16 or more on the CES-D recruited from 30 randomly selected Australian family practices. Depressive symptoms are measured using PHQ-9 at 3, 6, 9 and 12 months. RESULTS Growth mixture modelling identified a five-class trajectory model as the best fitting (lowest Bayesian Information Criterion): three groups were static (mild (n=532), moderate (n=138) and severe (n=69)) and two were dynamic (decreasing severity (n=32) and increasing severity (n=18)). The mild symptom trajectory was the most common (n=532). The severe symptom trajectory group (n=69) differed significantly from the mild symptom trajectory group on most variables. The severe and moderate groups were characterised by high levels of disadvantage, abuse, morbidity and disability. Decreasing and increasing severity trajectory classes were similar on most variables. LIMITATIONS Adult only cohort, self-report measures. CONCLUSIONS Most symptom trajectories remained static, suggesting that depression, as it presents in primary care, is not always an episodic disorder. The findings indicate future directions for building prognostic models to distinguish those who are likely to have a mild course from those who are likely to follow more severe trajectories. Determining appropriate clinical responses based upon a likely depression course requires further research.
Collapse
Affiliation(s)
- Jane Gunn
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Bland RC, Streiner DL. Why screening for depression in primary care is impractical. CMAJ 2013; 185:753-4. [PMID: 23670151 DOI: 10.1503/cmaj.130634] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Roger C Bland
- Department of Psychiatry, University of Alberta, Edmonton, Alta.
| | | |
Collapse
|
26
|
Stanners M, Barton C, Shakib S, Winefield H. The prevalence of depression amongst outpatients with multimorbidity. Health (London) 2013. [DOI: 10.4236/health.2013.54106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
27
|
Seeley-Wait E, Abbott MJ, Rapee RM. Psychometric properties of the mini-social phobia inventory. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 11:231-6. [PMID: 19956461 DOI: 10.4088/pcc.07m00576] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 10/15/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although a potentially useful measure, to date, there has been only one published test of the psychometric properties of the Mini-Social Phobia Inventory (Mini-SPIN). Therefore, the psychometric properties of the Mini-SPIN, a brief 3-item screen for social anxiety disorder, were examined. METHOD Participants were 186 patients diagnosed with social anxiety disorder (DSM-IV criteria) attending a specialized anxiety disorders clinic for treatment, and 56 nonclinical participants were recruited to serve as comparisons. Participants were diagnosed using the Anxiety Disorders Interview Schedule for DSM-IV, and they also completed the Mini-SPIN, the Social Interaction Anxiety Scale (SIAS), and the Social Phobia Scale (SPS). Construct validity for the Mini-SPIN was assessed by its correlations with the SIAS and the SPS. Reliability, internal consistency, discriminant validity, and sensitivity to change were also examined, and receiver operating characteristic curve analysis was conducted to determine guidelines regarding cutoff scores for the Mini-SPIN. The study was conducted between April 1999 and December 2001. RESULTS Supporting findings from a previous study, strong support was found for the Mini-SPIN's ability to discriminate individuals with social anxiety disorder from those without the disorder. Receiver operating characteristic analysis revealed that using a cutoff score of 6 or greater (P < .001), the Mini-SPIN demonstrates excellent sensitivity, specificity, and positive and negative predictive values. CONCLUSIONS Findings suggest that the Mini-SPIN is a reliable and valid instrument for screening social anxiety disorder in adults. Importantly, the use of the Mini-SPIN in primary care may be one way to address the underrecognition of social anxiety disorder in such settings. Due to the ease and brevity of the measure, it also shows potential for use in epidemiology. Given that this study has revealed the ability of the Mini-SPIN to reflect treatment change, the Mini-SPIN may also be considered for use in treatment outcome studies that specifically require minimal assessment.
Collapse
|
28
|
Melrose KL, Brown GDA, Wood AM. Am I Abnormal? Relative Rank and Social Norm Effects in Judgments of Anxiety and Depression Symptom Severity. JOURNAL OF BEHAVIORAL DECISION MAKING 2012. [DOI: 10.1002/bdm.1754] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Alex M. Wood
- School of Psychological Sciences; University of Manchester; Manchester; UK
| |
Collapse
|
29
|
Lynch JM, Askew DA, Mitchell GK, Hegarty KL. Beyond symptoms: Defining primary care mental health clinical assessment priorities, content and process. Soc Sci Med 2012; 74:143-9. [DOI: 10.1016/j.socscimed.2011.08.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 05/10/2011] [Accepted: 08/24/2011] [Indexed: 12/18/2022]
|
30
|
Su JA, Tsai CS, Hung TH, Chou SY. Change in accuracy of recognizing psychiatric disorders by non-psychiatric physicians: five-year data from a psychiatric consultation-liaison service. Psychiatry Clin Neurosci 2011; 65:618-23. [PMID: 22176280 DOI: 10.1111/j.1440-1819.2011.02272.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM Psychiatric disorders are easily underestimated and under-recognized by physicians. The aim of the present study was to investigate the change in accuracy of recognizing psychiatric symptoms. METHODS Consecutive 5-year consultation-liaison data were collected and patients with one of the five common psychiatric diagnoses, including depressive disorders, substance use disorders, delirium, anxiety disorders and psychotic disorders, were chosen for analysis. The primary care physician's initial impression of a psychiatric diagnosis was recorded based on their reason for referral on the referral sheets. Accurate recognition was defined as matching of the physician's initial impression with the psychiatrist's final diagnosis. Mentioning the core symptoms of psychiatric diagnostic criteria or common synonyms would be considered as correct recognition. RESULTS The overall accuracy of recognition was 41.5% and there was no significant change during this 5-year period. Substance use disorders were the one diagnosis with the highest agreement, followed by delirium, depressive disorders, anxiety disorders, and psychotic disorders. As for the factors associated with accurate recognition, male patients or those with multiple physical illnesses were more likely to have their psychiatric symptoms recognized correctly. CONCLUSIONS Without comprehensive postgraduate psychiatric education, the accuracy of recognizing psychiatric symptoms does not improve year by year. Education should focus on common psychiatric problems among medical inpatients, especially those easily misdiagnosed, such as depression and delirium.
Collapse
Affiliation(s)
- Jian-An Su
- Department of Psychiatry, Chang Gung Memorial Hospital at Chiayi, Taiwan
| | | | | | | |
Collapse
|
31
|
Barley EA, Murray J, Walters P, Tylee A. Managing depression in primary care: A meta-synthesis of qualitative and quantitative research from the UK to identify barriers and facilitators. BMC FAMILY PRACTICE 2011; 12:47. [PMID: 21658214 PMCID: PMC3135545 DOI: 10.1186/1471-2296-12-47] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 06/09/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Current management in primary care of depression, with or without comorbid physical illness, has been found to be suboptimal. We therefore conducted a systematic review to identify clinician perceived barriers to and facilitators for good depression care. METHODS We conducted a systematic literature search to identify qualitative and quantitative studies published in the UK since 2000 of GPs' and practice nurses' attitudes to the management of depression. We used principles from meta-ethnography to identify common and refuted themes across studies. RESULTS We identified 7 qualitative and 10 quantitative studies; none concerned depression and co-morbid physical illness of any kind. The studies of managing patients with a primary diagnosis of depression indicated that GPs and PNs are unsure of the exact nature of the relationship between mood and social problems and of their role in managing it. Among some clinicians, ambivalent attitudes to working with depressed people, a lack of confidence, the use of a limited number of management options and a belief that a diagnosis of depression is stigmatising complicate the management of depression. CONCLUSIONS Detection and management of depression is considered complex. In particular, primary care clinicians need guidance to address the social needs of depressed patients. It is not known whether the same issues are important when managing depressed people with co-morbid physical illness.
Collapse
Affiliation(s)
- Elizabeth A Barley
- Section of Primary Care Mental Health, Health Services and Population Research Department, PO Box 28, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | | | | | | |
Collapse
|
32
|
Cameron IM, Lawton K, Reid IC. Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care. J Affect Disord 2011; 130:99-105. [PMID: 21055827 DOI: 10.1016/j.jad.2010.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-psychiatric physicians are better at correctly ruling out depressive disorders than appropriately recognising them. However, given large numbers of non-depressed patients, a small percentage of false positives equates to a greater number of patients than the number of depressed patients that GPs fail to detect. Concern thus arises that substantial numbers of patients with falsely identified depression may receive inappropriate interventions. METHODS Unselected GP consulters were screened with the Hospital Anxiety and Depression Scale (HADS). GPs' perceptions of depression were independently rated on an ICD-10 scale. Case records were reviewed. Analysis related to participants with HADS-D<8. Data were assessed of 660 participants with sub-threshold symptoms. Factors were assessed according to GP ratings. RESULTS GP perceived depression in false positive cases were more likely at index visit, to have a mental health presenting problem (OR=6.74 (95% CI=3.21, 14.16); receive antidepressant prescriptions (OR 3.79 (95% CI=1.69, 8.49) and have greater severity of HADS-D score (OR 1.18 (95% CI=1.01, 1.38). Subthreshold cases that GPs identified as depressed, more often had a recording, over subsequent six months, of: depressive symptoms (16 (35%) versus 26 (7%), p<0.001); antidepressant prescriptions (11 (24%) versus 25 (7%), p=0.001); and Community Mental Health Team referrals (4 (9%) versus 1 (<1%), p=0.001). They also consulted GPs more frequently than those not identified (median=5 (IQR 2.8, 6.3) versus median=3 (IQR=2, 5), p=0.004 over six months. LIMITATIONS The HADS is not a diagnostic tool. CONCLUSIONS GPs' diagnoses of depressive disorder in patients with sub-threshold symptoms were appropriate. Interventions offered to this group were consistent with documented previous histories.
Collapse
Affiliation(s)
- Isobel M Cameron
- Applied Health Sciences (Mental Health), University of Aberdeen, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen, AB25 2ZH, United Kingdom.
| | | | | |
Collapse
|
33
|
Mitchell AJ, Vahabzadeh A, Magruder K. Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research. Psychooncology 2011; 20:572-84. [PMID: 21442689 DOI: 10.1002/pon.1943] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/10/2011] [Accepted: 01/25/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There has been at least 40 years of active research on screening for depression and distress in primary care. Both successes and failures have been documented. The purpose of this focussed narrative review was to summarise this research and present the key lessons for clinicians and researchers working in psychosocial oncology. METHODS We searched for studies assessing the utility of screening in primary care in seven electronic bibliographic databases (CENTRAL, CINAHL, Embase, HMIC, Medline, PsycINFO, Web of Knowledge) from inception to December 2010. Results were reviewed and summarised into key areas. RESULTS We found that research could be distilled into the following key learning points. (1) Primary care is an important partner in psychosocial care. (2) Both over and under detection are problematic. (3) Barriers to identification involve patient and clinician factors. (4) Acceptability of screening is critical to implementation. (5) Underserved groups need special attention in screening. (6) Patient-clinician trust is an important modifiable variable. (7) Greater contact influences detection. (8) Clinician confidence/skills influence screening success and subsequent action. (9) Training may improve confidence but effects upon long-term outcomes are modest. (10) Screening is generally ineffective without aftercare. CONCLUSIONS Primary care has shown largely what does not work in relation to screening. Namely relying on clinicians' unassisted judgement without infrastructural support, using over-complex scales with low acceptability, looking for depression alone, using screening without linked treatment, treating in the absence of follow-up and failing to engage patients in their own care. These pitfalls can and should be avoided in psychosocial oncology.
Collapse
|
34
|
Rodrigo Erazo R. Hacia un modelo de diagnóstico precoz en las enfermedades mentales. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
35
|
Abstract
PURPOSE We wanted to demonstrate a method for calculating the relative complexity of ambulatory clinical encounters. METHODS Measures of complexity should reflect the complexity of the typical encounter and across encounters. If inputs represent the information transferred from the patient to the physician, then inputs include history, physical examination, testing, diagnoses, and patient demographics. Outputs include medications prescribed and other therapies used, including education and counseling, procedures performed, and disposition. The complexity of each input/output is defined as the mean input/output quantity per clinical encounter weighted by its inter-encounter diversity (range of possibilities used) and variability (visit-to-visit change). In complex systems, as the information in the input increases linearly, the complexity of the system increases exponentially. To assess the impact of the complexity of the encounter on the physician, we adjusted the estimated complexity by the duration-of-visit. RESULTS Using the 2000 NAMCS database, we calculated input and output complexities for 3 specialties. Construct validity was affirmed by comparing the relative rankings of complexity against relative rankings using other complexity-related measures. Although total relative complexity was similar for family medicine (44.04 +/- 0.0024 SE) and cardiology (42.78 +/- 0.0004 standard error [SE]), when adjusted for duration-of-visit, family medicine had a greater complexity density per hour (167.33 +/- 0.0095 SE) than either cardiology (125.4 +/- 0.0117 SE) or psychiatry (31.21 +/- 0.0027 SE). CONCLUSIONS This method estimates complexity based on the amount of care provided weighted by its diversity and variability. Such estimates could have broad use for interphysician comparisons as well as longitudinal applications.
Collapse
Affiliation(s)
- David A Katerndahl
- Family & Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
| | | | | |
Collapse
|
36
|
Authors' response. Br J Gen Pract 2010; 60:213. [DOI: 10.3399/bjgp10x483580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
37
|
Fernández A, Pinto-Meza A, Bellón JA, Roura-Poch P, Haro JM, Autonell J, Palao DJ, Peñarrubia MT, Fernández R, Blanco E, Luciano JV, Serrano-Blanco A. Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study. Gen Hosp Psychiatry 2010; 32:201-9. [PMID: 20302995 DOI: 10.1016/j.genhosppsych.2009.11.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/18/2009] [Accepted: 11/19/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria. METHODS Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed. RESULTS GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP. CONCLUSION GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.
Collapse
Affiliation(s)
- Anna Fernández
- Sant Joan de Déu-SSM, Fundació Sant Joan de Déu, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Sicras-Mainar A, Blanca-Tamayo M, Gutiérrez-Nicuesa L, Salvatella-Pasant J, Navarro-Artieda R. Clinical validity of a population database definition of remission in patients with major depression. BMC Public Health 2010; 10:64. [PMID: 20149222 PMCID: PMC2829005 DOI: 10.1186/1471-2458-10-64] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 02/11/2010] [Indexed: 11/10/2022] Open
Abstract
Background Major depression (MD) is one of the most frequent diagnoses in Primary Care. It is a disabling illness that increases the use of health resources. Aim: To describe the concordance between remission according to clinical assessment and remission obtained from the computerized prescription databases of patients with MD in a Spanish population. Methods Design: multicenter cross-sectional. The population under study was comprised of people from six primary care facilities, who had a MD episode between January 2003 and March 2007. A specialist in psychiatry assessed a random sample of patient histories and determined whether a certain patient was in remission according to clinical criteria (ICPC-2). Regarding the databases, patients were considered in remission when they did not need further prescriptions of AD for at least 6 months after completing treatment for a new episode. Validity indicators (sensitivity [S], specificity [Sp]) and clinical utility (positive and negative probability ratio [PPR] and [NPR]) were calculated. The concordance index was established using Cohen's kappa coefficient. Significance level was p < 0.05. Results 133 patient histories were reviewed. The kappa coefficient was 82.8% (confidence intervals [CI] were 95%: 73.1 - 92.6), PPR 9.8% and NPR 0.1%. Allocation discrepancies between both criteria were found in 11 patients. S was 92.5% (CI was 95%: 88.0 - 96.9%) and Sp was 90.6% (CI was 95%: 85.6 - 95.6%), p < 0.001. Reliability analysis: Cronbach's alpha: 90.6% (CI was 95%: 85.6 - 95.6%). Conclusions Results show an acceptable level of concordance between remission obtained from the computerized databases and clinical criteria. The major discrepancies were found in diagnostic accuracy.
Collapse
Affiliation(s)
- Antoni Sicras-Mainar
- Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain, Gaietà Soler, 6-8 entlo, 08911 Badalona, Barcelona, Spain.
| | | | | | | | | |
Collapse
|
39
|
Rait G, Walters K, Griffin M, Buszewicz M, Petersen I, Nazareth I. Recent trends in the incidence of recorded depression in primary care. Br J Psychiatry 2009; 195:520-4. [PMID: 19949202 DOI: 10.1192/bjp.bp.108.058636] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of data describing how general practitioners (GPs) label or record depression. AIMS To determine incidence and sociodemographic variation in GP-recorded depression diagnoses and depressive symptoms. METHOD Annual incidence rates calculated using data from 298 UK general practices between 1996 and 2006, adjusted for year of diagnosis, gender, age and deprivation. RESULTS Incidence of diagnosed depression fell from 22.5 to 14.0 per 1000 person-years at risk (PYAR) from 1996 to 2006. The incidence of depressive symptoms rose threefold from 5.1 to 15.5 per 1000 PYAR. Combined incidence of diagnoses and symptoms remained stable. Diagnosed depression and symptoms were more common in women and in more deprived areas. CONCLUSIONS Depression recorded by general practitioners has lower incidence rates than depression recorded in epidemiological studies, although there are similar associations with gender and deprivation. General practitioners increasingly use symptoms rather than diagnostic labels to categorize people's illnesses. Studies using standardised diagnostic instruments may not be easily comparable with clinical practice.
Collapse
Affiliation(s)
- Greta Rait
- MRC General Practice Research Framework, Stephenson House, 158-160 North Gower Street, London NW1 2ND, UK.
| | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Appropriateness of antidepressant prescribing: an observational study in a Scottish primary-care setting. Br J Gen Pract 2009; 59:644-9. [PMID: 19761665 DOI: 10.3399/bjgp09x454061] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Since the 1990s, Scottish community-based antidepressant prescribing has increased substantially. AIM To assess whether GPs prescribe antidepressants appropriately. DESIGN OF STUDY Observational study of adults (aged >/=16 years) screened with the Hospital Anxiety and Depression Scale (HADS) attending a GP. SETTING Four practices in Grampian, Scotland. METHOD Patients (n = 898) completed the HADS, and GPs independently estimated depression status. Notes were scrutinised for evidence of antidepressant use, and the appropriateness of prescribing was assessed. RESULTS A total of 237 (26%) participants had HADS scores indicating 'possible' (15%) or 'probable' (11%) depression. The proportion of participants rated as depressed by their GP differed significantly by HADS depression subscale scores. Odds ratio for 'possible' versus 'no' depression was 3.54 (95% confidence interval [CI] = 2.17 to 5.76, P<0.001); and for 'probable' versus 'possible' depression was 3.59 (95% CI = 2.06 to 6.26, P<0.001). Similarly, the proportion of participants receiving antidepressants differed significantly by HADS score. Odds ratio for 'possible' versus 'no' depression was 2.79 (95% CI = 1.70 to 4.58, P<0.001); and for 'probable' versus 'possible' was 2.12 (95% CI = 1.21 to 3.70, P = 0.009). In 101 participants with 'probable' depression, GPs recognised 53 (52%) participants as having a clinically significant depression. Inappropriate initiation of antidepressant treatment occurred very infrequently. Prescribing to participants who were not symptomatic was accounted for by the treatment of pain, anxiety, or relapse prevention, and for ongoing treatment of previously identified depression. CONCLUSION There was little evidence of prescribing without relevant indication. Around half of patients with significant symptoms were not identified by their GP as suffering from a depressive disorder: this varied inversely with severity ratings. Rather than prescribing indiscriminately (as has been widely assumed), it is likely that GPs are initiating antidepressant treatment conservatively.
Collapse
|
42
|
Smolders M, Laurant M, Verhaak P, Prins M, van Marwijk H, Penninx B, Wensing M, Grol R. Adherence to evidence-based guidelines for depression and anxiety disorders is associated with recording of the diagnosis. Gen Hosp Psychiatry 2009; 31:460-9. [PMID: 19703640 DOI: 10.1016/j.genhosppsych.2009.05.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 04/23/2009] [Accepted: 05/21/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess professionals' adherence to evidence-based guidelines and to investigate whether or not this is influenced by recording of the diagnosis and symptom severity. METHOD Analysis of baseline cross-sectional data of a cohort study of 721 primary care patients with a confirmed diagnosis of a depressive or anxiety disorder. Information on the management of depressive and anxiety disorders was gathered from the electronic medical patient records. Guideline adherence was measured by an algorithm, based on performance indicators. RESULTS Forty-two percent of the patients with a depressive disorder was treated in accordance with the guideline, whereas 27% of the patients with an anxiety disorder received guideline-consistent care. The provision of care in line with current depression and anxiety guidelines was around 50% for persons with both types of disorders. Documentation of an International Classification of Primary Care diagnosis of depression or anxiety disorder appeared to have a strong influence on guideline adherence. Symptom severity, however, did not influence guideline adherence. CONCLUSIONS Adherence to depression and anxiety guidelines can be improved, even when the general practitioner makes the diagnosis and records it. Data on actual health care delivery and quality of care provide insight and may be useful in developing quality improvement activities.
Collapse
Affiliation(s)
- Mirrian Smolders
- Scientific Institute for Quality of Health Care, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Torzsa P, Szeifert L, Dunai K, Kalabay L, Novák M. Diagnosis and therapy of depression in primary care. Orv Hetil 2009; 150:1684-93. [DOI: 10.1556/oh.2009.28675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A depresszió a külföldi és hazai felmérések szerint is a leggyakoribb pszichiátriai tünetegyüttes. Nyugat-Európában a major depresszió élettartam-prevalenciája 13%, egyéves prevalenciája 4% körül alakul. Magyarországon is hasonló a súlyos depresszió előfordulási aránya; a családorvosnál megjelenő betegek mintegy 5–8%-ánál diagnosztizálható valamilyen depresszív zavar. A megbetegedés nők körében és az életkor előrehaladtával gyakrabban fordul elő. Az Egészségügyi Világszervezet szerint a depresszió jelenleg a harmadik leggyakoribb munkaképesség-csökkenésért felelős betegség. A kórkép jelentőségét növeli, hogy nagymértékben rontja az életminőséget, gyakran társul szorongással, alvászavarokkal, alkohol- és drogfüggőséggel, valamint egyes szomatikus kórképekkel. A depresszió az öngyilkosság legfőbb rizikófaktora. A depresszió szűrésében, diagnosztizálásában nagy szerep jut a családorvosnak. Nemcsak a levert hangulatról, szomorúságról, öngyilkossági gondolatokról panaszkodó beteg esetén kell depresszióra gondolni, hanem szervi betegséggel nem magyarázható egyéb tünetek, fejfájás, fáradékonyság, hasi fájdalom, gastrointestinalis panaszok, testsúlyváltozás esetén is. A családorvosnak megfelelő ismeretekkel kell rendelkeznie a különböző terápiás lehetőségekről – pszichoterápiás módszerekről, antidepresszív gyógyszerekről, egyéb terápiás lehetőségekről –, hogy betegét hatékonyan tudja kezelni, szükség esetén a pszichológussal, pszichiáter szakorvossal együttműködve. Jelen közleményünkben bemutatjuk a depresszió jelentőségét és előfordulási gyakoriságát vizsgáló irodalmi adatokat, valamint összefoglaljuk a depresszió diagnosztikus és terápiás lehetőségeit a családorvosi gyakorlatban.
Collapse
Affiliation(s)
- Péter Torzsa
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | | | - Klaudia Dunai
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - László Kalabay
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | | |
Collapse
|
44
|
Affiliation(s)
- Peter Tyrer
- Department of Psychological Medicine, Imperial College London, London W6 8RP, UK.
| |
Collapse
|
45
|
Abstract
BACKGROUND Depression is a major burden for the health-care system worldwide. Most care for depression is delivered by general practitioners (GPs). We assessed the rate of true positives and negatives, and false positives and negatives in primary care when GPs make routine diagnoses of depression. METHODS We undertook a meta-analysis of 118 studies that assessed the accuracy of unassisted diagnoses of depression by GPs. 41 of these studies were included because they had a robust outcome standard of a structured or semi-structured interview. FINDINGS 50 371 patients were pooled across 41 studies and examined. GPs correctly identified depression in 47.3% (95% CI 41.7% to 53.0%) of cases and recorded depression in their notes in 33.6% (22.4% to 45.7%). 19 studies assessed both rule-in and rule-out accuracy; from these studies, the weighted sensitivity was 50.1% (41.3% to 59.0%) and specificity was 81.3% (74.5% to 87.3%). At a rate of 21.9%, the positive predictive value was 42.0% (39.6% to 44.3%) and the negative predictive value was 85.8% (84.8% to 86.7%). This finding suggests that for every 100 unselected cases seen in primary care, there are more false positives (n=15) than either missed (n=10) or identified cases (n=10). Accuracy was improved with prospective examination over an extended period (3-12 months) rather than relying on a one-off assessment or case-note records. INTERPRETATION GPs can rule out depression in most people who are not depressed; however, the modest prevalence of depression in primary care means that misidentifications outnumber missed cases. Diagnosis could be improved by re-assessment of individuals who might have depression. FUNDING None.
Collapse
Affiliation(s)
- Alex J Mitchell
- Leicestershire Partnership Trust, Leicester General Hospital, Leicester, UK.
| | | | | |
Collapse
|
46
|
Buntinx F, De Lepeleire J, Heyrman J, Fischler B, Vander Mijnsbrugge D, Van den Akker M. Diagnosing depression: What's in a name? Eur J Gen Pract 2009; 10:162-5, 168. [PMID: 15724127 DOI: 10.3109/13814780409044305] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Large and undeclared differences exist between incidence and prevalence rates of depression in general practice based morbidity registries, and in registries based on questionnaires of questionnaire-based interviews. We tried to identify possible explanations for these differences. METHOD Literature-based discussions were held among a multidisciplinary group of clinicians and researchers. FINDINGS Selection bias and imperfections in the diagnostic capabilities of each of the systems may play a role, but they are insufficient explanations for the differences that were identified. Questionnaires provide factual information on a patient's situation. Frequently no information is available on the intensity or consistency of the symptoms and on the personal growth or coping strategies that were developed by the patient. GPs may register depressive complaints as part of other psychological problems to which the depression is related. Their diagnostic strategy is part of a process to identify those who can benefit from specific interventions. In general practice, depression is a diagnosis that tends to emerge progressively. Depression can be considered as a way of coping with events. DSM-based questionnaires provide information that is more related to a latent characteristic of a personality, rather than a temporal, inappropriate expression of this characteristic, as identified in a clinical diagnosis. INTERPRETATION Conceptual differences and different objectives when diagnosing, more than selection bias or diagnostic imperfections, tend to be responsible for the identified differences in occurrence rates of depression.
Collapse
Affiliation(s)
- Frank Buntinx
- Department of Gneral Practice, University of Leuven, B 3000 Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
47
|
Baas KD, Wittkampf KA, van Weert HC, Lucassen P, Huyser J, van den Hoogen H, van de Lisdonk E, Bindels PE, Bockting CL, Ruhé HG, Schene AH. Screening for depression in high-risk groups: prospective cohort study in general practice. Br J Psychiatry 2009; 194:399-403. [PMID: 19407268 DOI: 10.1192/bjp.bp.107.046052] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Currently only about half of the people who have major depressive disorder are detected during regular health care. Screening in high-risk groups might be a possible solution. AIMS To evaluate the effectiveness of selective screening for major depressive disorder in three high-risk groups in primary care: people with mental health problems, people with unexplained somatic complaints and people who frequently attend their general practitioner. METHOD Prospective cohort study among 2005 people in high-risk groups in three health centres in The Netherlands. RESULTS Of the 2005 people identified, 1687 were invited for screening and of these 780 participated. Screening disclosed 71 people with major depressive disorder: 36 (50.7%) already received treatment, 14 (19.7%) refused treatment and 4 individuals did not show up for an appointment. As a final result of the screening, 17 individuals (1% of 1687) started treatment for major depressive disorder. CONCLUSIONS Screening for depression in high-risk populations does not seem to be effective, mainly because of the low rates of treatment initiation, even if treatment is freely and easily accessible.
Collapse
Affiliation(s)
- Kim D Baas
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Caballero L, Aragonès E, García-Campayo J, Rodríguez-Artalejo F, Ayuso-Mateos JL, Polavieja P, Gómez-Utrero E, Romera I, Gilaberte I. Prevalence, characteristics, and attribution of somatic symptoms in Spanish patients with major depressive disorder seeking primary health care. PSYCHOSOMATICS 2009; 49:520-9. [PMID: 19122129 DOI: 10.1176/appi.psy.49.6.520] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Somatic symptoms (SS) tend to dominate clinical symptomatology in patients with depression in primary care. OBJECTIVE The authors performed a cross-sectional nationwide epidemiological study on 1,150 primary-care patients with major depression and evaluated the prevalence of SS and physicians' attribution of their origin. METHOD Patients were administered the Structured Polyvalent Psychiatric Interview. RESULTS Ninety-three percent of patients had at least one SS fully or partially attributed to depression, and 45% of patients had four to nine. Painful symptoms, despite being the most frequent, were the least often attributed to depression (fewer than 25% of patients with pain) and significantly more often attributed to a combined origin. CONCLUSION Results suggest that primary-care physicians tend to associate pain with depression to a significantly lesser extent than any other somatic symptom (e.g., cardiopulmonary or gastrointestinal). Therefore, special attention should be given to painful symptoms in order to ensure efficient management of depression in primary care.
Collapse
Affiliation(s)
- Luis Caballero
- Clinical Research Department, Lilly, SA, Avenida de la Industria 30, Alcobendas E-28108, Madrid, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Kendrick T, Dunn N, Robinson S, Oestmann A, Godfrey K, Cooper C, Inskip H. A longitudinal study of blood folate levels and depressive symptoms among young women in the Southampton Women's Survey. J Epidemiol Community Health 2009; 62:966-72. [PMID: 18854500 DOI: 10.1136/jech.2007.069765] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lower blood folate levels have been associated with depression in cross-sectional surveys, but no studies have examined the relationship prospectively to determine whether the relationship is causal. A follow-up study was designed to examine whether lower blood folate levels predict incident depressive symptoms. METHOD Women aged 20-34 years registered in general practices in Southampton, UK, were asked to participate. Baseline assessment included the general health questionnaire (GHQ-12) measure of anxiety and depression, and socioeconomic factors, diet, smoking and alcohol intake. Two years later, participants' general practice (GP) records were examined for evidence of incident symptoms of depression. RESULTS At baseline, 5051 women completed the GHQ-12 and had red cell folate levels measured, of whom 1588 (31.4%) scored above the threshold for case level symptoms of anxiety and depression on the GHQ-12. Two years later, GP records for 3996 (79.1%) were examined, but 1264 with baseline evidence of depression were excluded from follow-up analysis. Incident depressive symptoms were recorded for 307 (11.2%) of the remaining 2732. Lower red cell folate levels were associated with caseness on the GHQ-12 (adjusted prevalence ratio 0.99 per 100 nmol/l red cell folate, 95% CI 0.98 to 1.00). No relationship was found between red cell folate levels and incident depressive symptoms over 2 years (adjusted hazard ratio 1.00, 95% CI 0.97 to 1.03). CONCLUSIONS Low folate levels were not associated with subsequent depressive symptoms. This suggests that lower blood folate levels may be a consequence rather than a cause of depressive symptoms.
Collapse
Affiliation(s)
- T Kendrick
- Primary Medical Care, University of Southampton School of Medicine, Aldermoor Health Centre, Southampton SO16 5ST, UK.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Knol MJ, Geerlings MI, Grobbee DE, Egberts ACG, Heerdink ER. Antidepressant use before and after initiation of diabetes mellitus treatment. Diabetologia 2009; 52:425-32. [PMID: 19130036 DOI: 10.1007/s00125-008-1249-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS Although current literature suggests an association between diabetes and depression, the direction of the association is unclear. We examined the temporal association between diabetes and depression by studying antidepressant and benzodiazepine use around the initiation of diabetes treatment. METHODS From a pharmacy registry database we selected 49,593 diabetic patients and a random sample of non-diabetic individuals (n = 154,441), all >40 years old. Antidepressant and benzodiazepine use was calculated for the 7 years before and 7 years after the index date. The index date in diabetes patients was defined as the date of initiation of diabetes medication. A random index date was assigned to non-diabetic individuals. Time-specific incidence rate ratios of antidepressant and benzodiazepine use were calculated for intervals of 1 year, 3 months and 1 month. RESULTS Antidepressant and benzodiazepine use was increased 2 months before and 3 months after the initiation of diabetes treatment compared with non-diabetic individuals. The strongest increase in incidence of antidepressant and benzodiazepine use was seen in the month after initiation of diabetes treatment with incidence rate ratios of 2.4 (95% CI 2.0-3.0) and 3.4 (95% CI 3.0-3.8) respectively, after adjustment for age, sex and Chronic Disease Score. CONCLUSIONS/INTERPRETATION The increased incidence of antidepressant and benzodiazepine use may be a consequence of the burden of disease, of starting with diabetes medication or of being diagnosed with diabetes. Our findings could also reflect earlier detection by their physician.
Collapse
Affiliation(s)
- M J Knol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
| | | | | | | | | |
Collapse
|