Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care

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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.
Original languageEnglish
Pages (from-to)99-105
Number of pages7
JournalJournal of Affective Disorders
Volume130
Issue number1-2
Early online date4 Nov 2010
DOIs
Publication statusPublished - Apr 2011

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Primary Health Care
Depression
Anxiety
Therapeutics
Depressive Disorder
Antidepressive Agents
Prescriptions
Mental Health
International Classification of Diseases
Psychiatry
Referral and Consultation
Physicians

Keywords

  • depression
  • primary care
  • diagnosis
  • false positive

Cite this

@article{730dd6d596f34712b25f928e1dc290a9,
title = "Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care",
abstract = "BackgroundNon-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.MethodsUnselected 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.ResultsGP 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.LimitationsThe HADS is not a diagnostic tool.ConclusionsGPs' diagnoses of depressive disorder in patients with sub-threshold symptoms were appropriate. Interventions offered to this group were consistent with documented previous histories.",
keywords = "depression, primary care , diagnosis , false positive",
author = "Cameron, {Isobel M.} and Kenneth Lawton and Reid, {Ian C.}",
year = "2011",
month = "4",
doi = "10.1016/j.jad.2010.10.010",
language = "English",
volume = "130",
pages = "99--105",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",
number = "1-2",

}

TY - JOUR

T1 - Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care

AU - Cameron, Isobel M.

AU - Lawton, Kenneth

AU - Reid, Ian C.

PY - 2011/4

Y1 - 2011/4

N2 - BackgroundNon-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.MethodsUnselected 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.ResultsGP 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.LimitationsThe HADS is not a diagnostic tool.ConclusionsGPs' diagnoses of depressive disorder in patients with sub-threshold symptoms were appropriate. Interventions offered to this group were consistent with documented previous histories.

AB - BackgroundNon-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.MethodsUnselected 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.ResultsGP 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.LimitationsThe HADS is not a diagnostic tool.ConclusionsGPs' diagnoses of depressive disorder in patients with sub-threshold symptoms were appropriate. Interventions offered to this group were consistent with documented previous histories.

KW - depression

KW - primary care

KW - diagnosis

KW - false positive

U2 - 10.1016/j.jad.2010.10.010

DO - 10.1016/j.jad.2010.10.010

M3 - Article

VL - 130

SP - 99

EP - 105

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

IS - 1-2

ER -