Book contents
- Frontmatter
- Contents
- Foreword
- Preface
- List of contributors
- 1 Introduction
- Part one At-risk groups
- Part two Early detection in primary care
- 9 Secondary prevention of childhood mental health problems
- 10 The secondary prevention of depression
- 11 The prevention of anxiety disorders
- 12 The prevention of eating disorders
- 13 The prevention of alcohol and drug misuse
- 14 Early detection of psychosis in primary care: initial treatment and crisis management
- Part three Limiting disability and preventing relapse
- Index
10 - The secondary prevention of depression
from Part two - Early detection in primary care
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- Foreword
- Preface
- List of contributors
- 1 Introduction
- Part one At-risk groups
- Part two Early detection in primary care
- 9 Secondary prevention of childhood mental health problems
- 10 The secondary prevention of depression
- 11 The prevention of anxiety disorders
- 12 The prevention of eating disorders
- 13 The prevention of alcohol and drug misuse
- 14 Early detection of psychosis in primary care: initial treatment and crisis management
- Part three Limiting disability and preventing relapse
- Index
Summary
The recognition of depression in general practice
Whilst general practitioners recognise much of the psychiatric morbidity suffered by their patients, a review found that overall around half goes unrecognised (Goldberg & Huxley, 1980). In major depression specifically, around a half of those identified by psychiatric research interviews go unrecognised by general practitioners, whether the patients are attending with a new episode of illness (Bridges & Goldberg, 1987) or for any reason (Skuse & Williams, 1984; Freeling et al., 1985). Although another 10% are subsequently recognised and 50% of those unrecognised will remit, the remaining 20% may remain unrecognised even after six months and may develop a chronic depression (Freeling et al., 1985).
General practitioners have a difficult and highly skilled task when faced with several presenting problems first to make a decision about the likelihood of a patient having a physical disorder, and if so whether it is mild or potentially life threatening, whilst simultaneously considering the possibility of emotional disorder also. With depression, this task is also made difficult by the frequency in general practice of presentations with somatic symptoms and of depression related to physical disorders.
Reasons why depression is missed
Two broad reasons why depression is missed in general practice settings are:
First, that patients whose depression is correctly recognised differ systematically in their personal characteristics (i.e. demographic, psychiatric or physical characteristics) or in what they mention to their general practitioners from those patients whose depression is missed (Box 10.1).
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- The Prevention of Mental Illness in Primary Care , pp. 167 - 187Publisher: Cambridge University PressPrint publication year: 1996
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