Depression in Primary Care: What More Do We Need to Know?:

摘要: AbbreviationsAD antidepressantFP family physicianGP general practitionerIAPT Increasing Access to Psychological TherapiesMDD major depressive disorderQOF Quality and Outcomes FrameworkIn this edition of The Canadian Journal Psychiatry, Dr Marilyn A Craven Roger Bland' cite studies suggesting that around 10% primary care patients are likely meet diagnostic criteria for MDD, numbers will rise as the baby boomer cohort ages prevalence chronic physical disease increases. They suggest persistently low rates detection, treatment, follow-up found in need addressing improve treatment adherence patient outcomes, newer evidencebased models case management collaborative be adopted, integrating depression with diseases.1Alongside very useful overview issues, Linda Gask2 reviews educating FPs about identification depression, points out simple education has largely failed change practice. She identifies perceived structural obstacles change, including a relative lack time resources care, but highlights tendency among conceptualize reactive or endogenous, subsequent uncertainty treating it face adverse life events difficulties.2 This implies perceive limits medical model inherent research described by Bland,1 take social factors into account, they uncertain how do so practice.We know onset is often provoked circumstances,3·4 differs markedly between populations, accordance adversity.5 Cross-sectional surveys using consistent MDD doubled US adults 1992 2002,6 all high-income countries saw yearon-year increases AD prescribing 1990s following introduction selective serotonin reuptake inhibitors,7 prompting talk epidemic, although we increased United Kingdom due proportion sufferers being put on long-term rather than incidence depression.7 Rates consulting actually seemed falling during period affluence from 2000 onwards,7-8 at least up until economic crash 2008.8 may well question extent which can ameliorate effects changes their patients' financial security, employment, housing. Anderson et al9 pointed 20 years ago case-level psychological distress population correlates highly mean level distress, indicating them thatThe mental health society integral reflects its political structure. At point psychiatric epidemiology prevention merge policy-they cannot exist apart.9·p 484Therefore, interventions most effective if affect whole highrisk tail. However, despite this, professionals faced people must best them, even solutions seem more make difference level.The recognition needs improved been questioned, old notion miss 50% cases doing disservice. Studies have suggested missed tend milder,10·" moderateto-severe where evidence benefit stronger, quite good." In World Health Organization naturalistic study, 15 cities world, whose went unrecognized had milder baseline were not worse outcomes those recognized. …