Hostname: page-component-7b7567c8c-mnklg Total loading time: 0 Render date: 2026-11-12T19:01:55.150Z Has data issue: false hasContentIssue false
  • English
  • Français

The care provided by general practitioners for persistent depression

Published online by Cambridge University Press:  16 April 2020

Titus W.D.P. Van Os,
Rob H.S. Van den Brink,
Klaas Van der Meer and
Johan Ormel
Titus W.D.P. Van Os*
Affiliation:
Mental Health Care Friesland, LeenwardenThe NetherlandsDepartment of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, P.O. Box 30, 001, 9700RBGroningen, The Netherlands
Rob H.S. Van den Brink
Affiliation:
Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, P.O. Box 30, 001, 9700RBGroningen, The Netherlands
Klaas Van der Meer
Affiliation:
Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, P.O. Box 30, 001, 9700RBGroningen, The NetherlandsDepartment of General Practice, University of Groningen, Groningen, The Netherlands
Johan Ormel
Affiliation:
Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, P.O. Box 30, 001, 9700RBGroningen, The Netherlands
*
*Corresponding author. E-mail address:t.w.d.p.van.os@med.umcg.nl (T.W.D.P. Van Os).
Get access

Abstract

Purpose.

To examine the care provided by general practitioners (GPs) for persistent depressive illness and its relationship to patient, illness and consultation characteristics.

Subjects and method.

Using the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC) a sample of 264 patients with ICD-10 depression was identified among consecutive primary care patients in the Netherlands. At 1-year follow-up 78 of these patients (30%) still fulfilled the criteria of an ICD-10 depression and were considered persistent cases. At baseline and follow-up the GPs specified their diagnosis and treatment. The extent of recognition as a mental health problem, accuracy of diagnosis as a depression and treatment in accordance with clinical guidelines for depression was examined. In addition it was examined whether these steps in adequate GP care for persistent depression were related to patient, illness and consultation characteristics.

Results.

Twenty percent of the persistent depression cases were not recognized at baseline or during follow-up, 28% was recognized but not accurately diagnosed, 17% was accurately diagnosed, but did not receive adequate treatment and 35% was treated adequately. Recognition was associated with psychological reason for encounter; accurate diagnosis with absence of activity limitation days; and adequate treatment with severity of depression and higher educational level.

Conclusion.

Non-recognition, misdiagnosis and inadequate treatment are not limited to patients with a relatively mild and brief depression but are also prominent in patients with a persistent depression, who consulted their GP 8.2 times on average during the year their depression persisted.

Keywords

Persistent depressionProcess of carePrimary care

Information

Type
Original article
Information
European Psychiatry , Volume 21 , Issue 2 , March 2006, pp. 87 - 92
Copyright
Copyright © Elsevier SAS 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Agency for Health Care Policy and Research. Depression in primary care: volume 2. Treatment of Major Depression. Clinical Practice Guideline, Number 5 Rockville: AHCPR Publication No. 93-0551; 1993.Google Scholar
Bensing, J.Verhaak, P.Psychische problemen in de huisartspraktijkveelvormiger en diffuser dan in de psychiatrie. Nederlands Tijdschrift voor Geneeskunde 1994;138:130–135 (3).Google Scholar
van den Brink, R.H.S.Ormel, J.Tiemens, B.Smit, A.Jenner, J.van der Meer, K.et al.Predictability of the 1-year course of depression and generalized anxiety in primary care. Gen. Hosp. Psychiatry 2002;24:156–163.CrossRefGoogle Scholar
Cooper-Patrick, L.Crum, R.M.Ford, D.E.Characteristics of patients with major depression who received care in general medical and specialty mental health settings. Med. Care 1994;32:15–24.CrossRefGoogle ScholarPubMed
Goldberg, D.P.Williams, P.A.User's Guide to the General Health Questionnaire. Windsor: Nfer Nelson. 1988.Google Scholar
Goldberg, D.Psychological disorders in general medical settings. Soc. Psychiatry Psychiatr. Epidemiol. 1996;31(1):1–2.Google ScholarPubMed
Goldberg, D.Privett, M.Üstün, B.Simon, G.Linden, M.The effects of detection and treatment on the outcome of major depression in primary care: a naturalistic study in 15 cities. Br. J. Gen. Pract. 1998;48:1840–1844.Google ScholarPubMed
Donoghue, J.Tylee, A.The treatment of depression; prescribing patterns of antidepressants in primary care in the UK. Br. J. Psychiatry 1996;168:164–168.CrossRefGoogle ScholarPubMed
Johnson, T.Martin, R.Morrell, J.Prescribing is short term and follow up poor. Br. Med. J. 1996;314:826.Google Scholar
Klinkman, M.S.Schwenk, T.L.Coyne, J.C.Depression in primary care-more like asthma than appendicitis: the Michigan depression project. Can. J. Psychiatry 1997;42:966–973.CrossRefGoogle Scholar
Lawrenson, R.A.Tyrer, F.Newson, R.B.Farmer, R.D.T.The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared. J. Affect. Disord. 2000;59:149–157.CrossRefGoogle ScholarPubMed
van Os, T.W.D.P.Ormel, J.van den Brink, R.H.S.Jenner, J.A.Van der Meer, K.Tiemens, B.G.et al.Training primary care physicians improves the management of depression. Gen. Hosp. Psychiatry 1999;21:168–176.CrossRefGoogle Scholar
van Os, T.W.D.P.van den Brink, R.H.S.Jenner, J.A.Van der Meer, K.Tiemens, B.Ormel, J.Effects on depression pharmacotherapy of a Dutch general practitioner training program. J. Affect. Disord. 2002;71:105–111.CrossRefGoogle ScholarPubMed
Simon, G.E.Von Korff, M.Piccinelle, M.Fullerton, C.Ormel, J.An international study of the relation between somatic symptoms and depression. N. Engl. J. Med. 1999;341(18):1329–1335.CrossRefGoogle Scholar
Thompson, C.Thompson, C.M.The prescription of antidepressants in general practice I: a critical review. Hum. Psychopharmacol. 1989;4:91–102.CrossRefGoogle Scholar
Tiemens, B.G.Ormel, J.Simon, G.E.Occurrence, recognition, and outcome of psychological disorders in primary care. Am. J. Psychiatry 1996;153(5):636–644.Google ScholarPubMed
Tiemens, B.Ormel, J.Jenner, J.A.Van der Meer, K.Van Os, T.W.D.P.Van den Brink, R.H.S.et al.Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes? Psychol. Med. 1999;29:833–845.CrossRefGoogle ScholarPubMed
Üstün, T.B.Sartorius, N.Mental illness in general health care, In: An International Study Chichister: Wiley Publishers; 1995.Google Scholar
Von Korff, M.Üstün, T.B.Methods of the WHO Collaborative Study on 'psychological problems in general health care'. Mental illness in general health care. An International Study Wiley Publishers; 1995.Google Scholar
Von Korff, M.Üstün, T.B.Ormel, J.Kaplan, I.Simon, G.E.Self-report disability in an international primary care study of psychological illness. J. Clin. Epidemiol. 1996;49:297–304.CrossRefGoogle Scholar
Van Weel-Baumgarten, E.M.Van Bosch, W.J.H.M.van den Hoogen, H.J.M.Zitman, F.G.The validity of the diagnosis in general practice: is using criteria for diagnosis as a routine the answer?. Br. J. Gen. Pract. 2000;50:284–287.Google Scholar
World Health Organization. Composite International Diagnostic Interview (CIDI), version 1.0. Geneva: WHO; 1990.Google Scholar
Submit a response

Comments

No Comments have been published for this article.