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Identification and management of depression in primary care settings. A meta-review of evidence

Published online by Cambridge University Press:  18 May 2011

Corrado Barbui  and
Michele Tansella
Corrado Barbui*
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona (Italy)
Michele Tansella
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona (Italy)
*
Address for correspondence: Dr. C. Barbui, Section of Psychiatry and Clinical Psychology, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy. Fax: +39-045-585871 E-mail: [email protected]
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Summary

Aim – The purpose of this review is to summarize the evidence base on the effectiveness of (a) screening for depression in primary care; (b) managing depression in primary care employing specific management strategies; (c) treating primary care depressive patients with antidepressants. Methods – Meta-review of all available reviews of the evidence. Results – Screening alone does not improve the recognition, management and outcome of depression in primary care settings. Management strategies, including (a) training primary care staff, (b) consultation-liaison, (c) collaborative care, (d) replacement/referral are supported by insufficient evidence to provide a definite answer as to the clinical effectiveness of individual models. Robust evidence exists to encourage physicians to prescribe effective doses of antidepressants in patients with moderate to severe depression who seek treatment in primary care settings. Conclusion – Population-level screening campaigns have a negative ratio of costs to benefits. However, at an individual-level of care increasing the ability of primary care physicians in recognising depression remains a relevant factor. Primary care physicians should consider whether depression is mild, moderate or severe. This patient categorisation help develop appropriate management and therapeutic strategies.

Declaration of Interest: none

Keywords

general practicedepressionepidemiologyantidepressants
Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 15 , Issue 4 , December 2006 , pp. 276 - 283
Copyright
Copyright © Cambridge University Press 2006

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References

Anderson, I.M. (1998). SSRIS versus tricyclic antidepressants in depressed inpatients: a meta-analysis of efficacy and tolerability. Depression and Anxiety 7, Suppl 1, 11–17.3.0.CO;2-I>CrossRefGoogle Scholar
Anderson, I.M. (2000). Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. Journal of Affective Disorders 58, 19–36.CrossRefGoogle ScholarPubMed
Anderson, I.M. (2001). Meta-analytical studies on new antidepressants. British Medical Journal 57, 161–178.Google ScholarPubMed
Arroll, B., Macgillivray, S., Ogston, S., Reid, I., Sullivan, F., Williams, B. & Crombie, I. (2005). Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis. Annals of Family Medicine 3. 449–456.CrossRefGoogle ScholarPubMed
Badamgarav, E., Weingarten, S.R., Henning, J.M., Knight, K., Hasselblad, V., Gano, A. Jr, & Ofman, J.J. (2003). Effectiveness of disease management programs in depression: a systematic review. American Journal of Psychiatry 160, 2080–2090.CrossRefGoogle ScholarPubMed
Balestrieri, M., Williams, P. & Wilkinson, G. (1988). Specialist mental health treatment in general practice: a meta-analysis. Psychological Medicine 18,711–717.CrossRefGoogle ScholarPubMed
Barbui, C. & Garattini, S. (2006). Mild depression in general practice: is the automatism of antidepressant prescribing an evidence-based approach? Ada Psychiatrica Scandinavica 113, 449–451.CrossRefGoogle ScholarPubMed
Barbui, C. & Hotopf, M. (2001). Amitriptyline, v.the rest: still the leading antidepressant after 40 years of randomised controlled trials. British Journal of Psychiatry 178, 129–144.CrossRefGoogle ScholarPubMed
Barbui, C. & Tansella, M. (2005). New generation psychotropics and the automatism of prescribing. International Review of Psychiatry 17, 139–141.CrossRefGoogle ScholarPubMed
Bellantuono, C, Mazzi, M.A., Tansella, M., Rizzo, R. & Goldberg, D. (2002). The identification of depression and the coverage of antidepressant drug prescriptions in Italian general practice. Journal of Affective Disorders 72, 53–59.CrossRefGoogle ScholarPubMed
Black, N. (2001). Evidence based policy: proceed with care. British Medical Journal 323, 275–279.CrossRefGoogle ScholarPubMed
Bower, P. & Gilbody, S. (2005). Managing common mental health disorders in primary care: conceptual models and evidence base. British Medical Journal 330, 839–842.CrossRefGoogle ScholarPubMed
Bower, P. & Sibbald, B. (2000a). Do consultation-liaison services change the behavior of primary care providers? A review. General Hospital Psychiatry 22, 84–96.CrossRefGoogle ScholarPubMed
Bower, P. & Sibbald, B. (2000b). On-site mental health workers in primary care: effects on professional practice. Cochrane Database of Systematic Reviews, Issue 4.Google Scholar
Bower, P. & Sibbald, B. (2000c). Systematic review of the effect of onsite mental health professionals on the clinical behaviour of general practitioners. British Medical Journal 320, 614–617.CrossRefGoogle ScholarPubMed
Brown, C. & Schulberg, H.C. (1995). The efficacy of psychosocial treatments in primary care. A review of randomized clinical trials. General Hospital Psychiatry 17, 414–424.Google ScholarPubMed
Churchill, R., Dewey, M., Gretton, V., Duggan, C, Chilvers, C. & Lee, A. (1999). Should general practitioners refer patients with major depression to counsellors? A review of current published evidence. Nottingham Counselling and Antidepressants in Primary Care (CAPC) Study Group. British Journal of General Practice 49, 738–743.Google Scholar
Cipriani, A., Barbui, C. & Geddes, J.R. (2005). Suicide, depression, and antidepressants. British Medical Journal 330, 373–374.CrossRefGoogle ScholarPubMed
Ciuna, A., Andretta, M., Corbari, L., Levi, D., Mirandola, M., Sorio, A. & Barbui, C. (2004). Are we going to increase the use of antidepressants up to that of benzodiazepines? European Journal of Clinical Pharmacology 60, 629–634.CrossRefGoogle ScholarPubMed
Cuijpers, P., van, S.A., Smits, N. & Smit, F. (in press). Screening and early psychological intervention for depression in schools: Systematic review and meta-analysis. European Child and Adolescent Psychiatry.Google Scholar
Del Piccolo, L. (2000). [Psychosocial problem disclosure during primary care consultations], Epidemiologia e Psichiatria Sociale 9, 257–271.CrossRefGoogle ScholarPubMed
Del Piccolo, L., Mazzi, M.A., Saltini, A. & Zimmermann, C. (2002). Inter and intra individual variations in physicians' verbal behaviour during primary care consultations. Social Science and Medicine 55, 1871–1885.CrossRefGoogle ScholarPubMed
Del Piccolo, L., Putnam, S.M., Mazzi, M.A. & Zimmermann, C. (2004). The biopsychosocial domains and the functions of the medical interview in primary care: construct validity of the Verona Medical Interview Classification System. Patient Education and Counselling 53, 47–56.CrossRefGoogle ScholarPubMed
Gask, L., Sibbald, B. & Creed, F. (1997). Evaluating models of working at the interface between mental health services and primary care. British Journal of Psychiatry 170, 6–11.CrossRefGoogle ScholarPubMed
Gensichen, J., Beyer, M., Muth, C, Gerlach, F.M., Von, K.M. & Ormel, J. (2006). Case management to improve major depression in primary health care: a systematic review. Psychological Medicine 36, 7–14.CrossRefGoogle ScholarPubMed
Gilbody, S., Whitty, P., Grimshaw, J. & Thomas, R. (2003). Educational and organizational interventions to improve the management of depression in primary care: a systematic review. Journal of the American Medical Association 289, 3145–3151.CrossRefGoogle ScholarPubMed
Gilbody, S., House, A.O. & Sheldon, T.A. (2005). Screening and case finding instruments for depression. Cochrane Database of Systematic Reviews, Issue 4.Google Scholar
Gilbody, S., Sheldon, T. & Wessely, S. (2006). Should we screen for depression? British Medical Journal 332, 1027–1030.CrossRefGoogle ScholarPubMed
Goldberg, D. (1984). The recognition of psychiatric illness by non-psychiatrists. Australian and New Zealand Journal of Psychiatry 18, 128–133.CrossRefGoogle ScholarPubMed
Goldberg, D. (2006). The “NICE Guideline” on the treatment of depression. Epidemiologia e Psichiatria Sociale 15, 11–15.CrossRefGoogle Scholar
Goldberg, D., Bridges, K., Duncan-Jones, P. & Grayson, D. (1988). Detecting anxiety and depression in general medical settings. British Medical Journal 297, 897–899.CrossRefGoogle ScholarPubMed
Helgason, T., Tomasson, H. & Zoega, T. (2004). Antidepressants and public health in Iceland. Time series analysis of national data. British Journal of Psychiatry 184, 157–162.Google Scholar
Huibers, M.J., Beurskens, A.J., Bleijenberg, G. & van Schayck, C.P. (2003). Psychosocial interventions delivered by general practitioners. Cochrane Database of Systematic Reviews, Issue 2.CrossRefGoogle Scholar
Hunkeler, E.M., Fireman, B., Lee, J., Diamond, R., Hamilton, J., He, C.X., Dea, R., Nowell, W.B. & Hargreaves, W.A. (2005). Trends in use of antidepressants, lithium, and anticonvulsants in Kaiser Permanenteinsured youths, 1994-2003. Journal of Child and Adolescent Psychopharmacology 15, 26–37.CrossRefGoogle ScholarPubMed
Kassianos, G. (2006). Barriers to treating depression in primary care. International Journal of Clinical Practice 60, 381–382.CrossRefGoogle ScholarPubMed
Katon, W. & Gonzales, J. (1994). A review of randomized trials of psychiatric consultationliaison studies in primary care. Psvchosomatics 35, 268–278.CrossRefGoogle ScholarPubMed
Kerwick, S., Jones, R., Mann, A. & Goldberg, D. (1997). Mental health care training priorities in general practice. British Journal of General Practice 47, 225–227.Google ScholarPubMed
MacGillivray, S., Arroll, B., Hatcher, S., Ogston, S., Reid, I., Sullivan, F., Williams, B. & Crombie, I. (2003). Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. British Medical Journal 326, 1014.CrossRefGoogle ScholarPubMed
Middleton, N., Gunnell, D., Whitley, E., Dorling, D. & Frankel, S. (2001). Secular trends in antidepressant prescribing in the UK, 1975-1998. Journal of Public Health Medicine 23, 262–267.CrossRefGoogle ScholarPubMed
Moncrieff, J. & Kirsch, I. (2005). Efficacy of antidepressants in adults. British Medical Journal 331, 155–157.CrossRefGoogle ScholarPubMed
Paykel, E.S. (2006). Depression: major problem for public health. Epidemiologia e Psichiatria Sociale 15, 4–10.CrossRefGoogle ScholarPubMed
Pignone, M.P., Gaynes, B.N., Rushton, J.L., Burchell, C.M., Orleans, C.T., Mulrow, C.D. & Lohr, K.N. (2002). Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine 136, 765–776.CrossRefGoogle ScholarPubMed
Poluzzi, E., Motola, D., Silvani, C, De, P.F., Vaccheri, A. & Montanaro, N. (2004). Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement. European Journal of Clinical Pharmacology 59,825–831.CrossRefGoogle ScholarPubMed
Schulberg, H.C., Raue, P.J. & Rollman, B.L. (2002). The effectiveness of psychotherapy in treating depressive disorders in primary care practice: clinical and cost perspectives. General Hospital Psychiatry 24, 203–212.CrossRefGoogle ScholarPubMed
Shepherd, M. (1995). Primary care psychiatry. Health services research is not enough. British Journal of Psychiatry 166, 1–3.CrossRefGoogle ScholarPubMed
Shepherd, M., Cooper, B., Brown, A., & Graham, K. (1966). Psychiatric Illness in General Practice, Oxford University Press: Oxford.Google Scholar
Simon, G.E. (2001). Treating depression in patients with chronic disease: recognition and treatment are crucial; depression worsens the course of a chronic illness. Western Journal of Medicine 175, 292–293.CrossRefGoogle ScholarPubMed
Simon, G.E. & Von Korff, M. (1995). Recognition, management, and outcomes of depression in primary care. Archives of Family Medicine 4, 99–105.CrossRefGoogle ScholarPubMed
Simon, G.E., VonKorff, M. & Barlow, W. (1995). Health care costs of primary care patients with recognized depression. Archives of General Psychiatry 52, 850–856.CrossRefGoogle ScholarPubMed
Spigset, O. & Martensson, B. (1999). Fortnightly review: drug treatment of depression. British Medical Journal 318, 1188–1191.CrossRefGoogle ScholarPubMed
Tansella, M. (2000). Making mental health services work at the primary level. Bulletin of the World Health Organisation 78, 501–502.Google ScholarPubMed
Tansella, M. (2006). Recent advances in depression. Where are we going? Epidemiologia e Psichiatria Sociale 15, 1–3.CrossRefGoogle ScholarPubMed
Tiemens, B.G., Ormel, J. & Simon, G.E. (1996). Occurrence, recognition, and outcome of psychological disorders in primary care. American Journal of Psychiatry 153, 636–644.Google ScholarPubMed
Tylee, A. & Jones, R. (2005). Managing depression in primary care. British Medical Journal 330, 800–801.CrossRefGoogle ScholarPubMed
US Preventive Services Task Force (1996). Guide to Clinical Preventive Services, 2nd ed., Williams & Wilkins: Baltimore.Google Scholar
US Preventive Services Task Force (2002). Screening for depression: recommendations and rationale. Annals of Internal Medicine 136, 760–764.CrossRefGoogle Scholar
Ustiin, T.B., Goldberg, D., Cooper, J., Simon, G.E. & Sartorius, N. (1995). New classification for mental disorders with management guidelines for use in primary care: ICD-10 PHC chapter five. British Journal of General Practice 45, 211–215.Google Scholar
Von Korff, M. & Goldberg, D. (2001). Improving outcomes in depression. British Medical Journal 323, 948–949.CrossRefGoogle ScholarPubMed
Weissman, M.M. (2006). Recent advances in depression across the generations. Epidemiologia e Psichiatria Sociale 15, 16–19.CrossRefGoogle ScholarPubMed
Zimmermann, C, Del, P.L. & Mazzi, M.A. (2003). Patient cues and medical interviewing in general practice: examples of the application of sequential analysis. Epidemiologia e Psichiatria Sociale 12, 115–123.CrossRefGoogle ScholarPubMed