Gaps in depression care: why primary care physicians should hone their depression screening, diagnosis, and management skills.

OBJECTIVE: To highlight the potential role that occupational and environmental physicians can play in providing high quality depression care by describing: the profound impact that depression can have on development and persistence of unexplained medical symptoms such as pain; the impact of depression on social and occupational functioning; the adverse effect of comorbid depression in patients with chronic medical illness on self-care and medical outcomes; and the significant direct and indirect costs associated with depression.
METHOD: Literature review.
RESULTS: Despite evidence-based treatment guidelines, suboptimal depression care persists.
CONCLUSIONS: Building on the tenets of the chronic illness care model as well as the principles of public health, three approaches are required to address the gaps between knowledge and practice: 1) improve accuracy of diagnosis; 2) prevent chronic depression; and 3) prevent relapse and recurrence.