BACKGROUND: A significant proportion of primary care patients are affected by a depressive disorder and about half of these patients are undetected and undertreated. METHODS: Twenty-five primary care physicians (PCPs) were recruited in five Italian centres. All consecutive patients who attended the PCPs' clinics in a 2-week period completed the Personal Health Questionnaire (PHQ), and those scoring more than nine on the PHQ were interviewed with the Hamilton Rating Scale for Depression-17 items (HDRS-17). The appropriateness of antidepressant drug treatment was assessed according to the decision to treat, the coverage, the type of drug and the dosage prescribed. RESULTS: The adjusted prevalence for ICD-10 depression in 2093 patients was 18.7%, while the conspicuous morbidity was 10.7%. The ability of PCPs to detect a depression increased proportionally with HDRS scores. The coverage, i. e. the proportion of patients who would benefit from an antidepressant (AD) and who actually received such drugs, was 20.9%. The drugs most frequently prescribed were SSRI (36 %), followed by TCA (21%) and by other AD. Most SSRI were prescribed at therapeutic dosage, while two-thirds of TCA were at sub-therapeutic dosage. About 37% of patients started a non-pharmacological treatment. The severity of depression at the first consultation predicted the persistence of a depressive state in the longer term. CONCLUSIONS: The ability of Italian PCPs to detect depression is satisfactory when the patient's depressive state is moderate or severe. The appropriateness of antidepressant drug treatment still needs to be improved.
BACKGROUND: A significant proportion of primary care patients are affected by a depressive disorder and about half of these patients are undetected and undertreated. METHODS: Twenty-five primary care physicians (PCPs) were recruited in five Italian centres. All consecutive patients who attended the PCPs' clinics in a 2-week period completed the Personal Health Questionnaire (PHQ), and those scoring more than nine on the PHQ were interviewed with the Hamilton Rating Scale for Depression-17 items (HDRS-17). The appropriateness of antidepressant drug treatment was assessed according to the decision to treat, the coverage, the type of drug and the dosage prescribed. RESULTS: The adjusted prevalence for ICD-10 depression in 2093 patients was 18.7%, while the conspicuous morbidity was 10.7%. The ability of PCPs to detect a depression increased proportionally with HDRS scores. The coverage, i. e. the proportion of patients who would benefit from an antidepressant (AD) and who actually received such drugs, was 20.9%. The drugs most frequently prescribed were SSRI (36 %), followed by TCA (21%) and by other AD. Most SSRI were prescribed at therapeutic dosage, while two-thirds of TCA were at sub-therapeutic dosage. About 37% of patients started a non-pharmacological treatment. The severity of depression at the first consultation predicted the persistence of a depressive state in the longer term. CONCLUSIONS: The ability of Italian PCPs to detect depression is satisfactory when the patient's depressive state is moderate or severe. The appropriateness of antidepressant drug treatment still needs to be improved.
Authors: Monica Cepoiu; Jane McCusker; Martin G Cole; Maida Sewitch; Eric Belzile; Antonio Ciampi Journal: J Gen Intern Med Date: 2007-10-26 Impact factor: 5.128
Authors: M Lanfredi; G Rossi; R Rossi; T Van Bortel; G Thornicroft; N Quinn; S Zoppei; A Lasalvia Journal: Epidemiol Psychiatr Sci Date: 2013-02-28 Impact factor: 6.892
Authors: Ellen Piek; Klaas van der Meer; Witte J G Hoogendijk; Brenda W J H Penninx; Willem A Nolen Journal: PLoS One Date: 2011-03-29 Impact factor: 3.240
Authors: Mauro Giovanni Carta; Eugenio Aguglia; Alberto Bocchetta; Matteo Balestrieri; Filippo Caraci; Massimo Casacchia; Liliana Dell'osso; Guido Di Sciascio; Filippo Drago; Carlo Faravelli; Maria Efisia Lecca; Maria Francesca Moro; Pier Luigi Morosini; Marcello Nardini; Gabriella Palumbo; Maria Carolina Hardoy Journal: Clin Pract Epidemiol Ment Health Date: 2010-08-27