From: Observational studies of depression in primary care: what do we know?
Author | Blacker et al. [59] | Grembowski et al. [51] | Groningen Primary Care Study [32-35,50,64,65] | Kessler et al. [61] | Kessler et al. [45,60] | Limosin et al. [43] | Longitudinal investigation of depression outcomes in primary care (LIDO) [39,40, 44,52,62] | Mental Health & General Practice Investigation (MaGPie) [63] | Manning et al. [48] |
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Location | England | US | Netherlands | US | England | France | Israel, Brazil, Spain, Australia, Russia, US | New Zealand | US |
Primary care setting/s | One health centre | 261 primary physicians in private practice from 72 offices | 25 General Practitioners | A multi-specialty group practice with 175 physicians | One general practice | 560 General Practitioners | 6 research sites Primary care & outpatient services, day care services, & inpatient hospital services | 70 General Practitioners | One private ambulatory family practice centre |
Selection of primary care setting | Not stated | Consenting GPs from Physician Referral Study | Representative sample | Not stated | Not stated | Randomly selected | Track record of international collaborative research | Randomly selected | Not stated |
Recruitment | Consecutive patients | Waiting room | Consecutive patients | Patients who used clinic | Consecutive patients | Each GP enrolled first patient to meet criteria for major depressive episode | Patients attending primary care facilities | All adult attenders | Consecutive non-referred patients presenting with impairment due to depression or anxiety |
Screen for depression/mental health | General Health Questionnaire (GHQ)-30, Schedule for Affective Disorders and Schizophrenia (SADS) | Symptom Checklist (SCL) -20 | GHQ-30 & rated by GP for current mental health problem | GHQ-30 | GHQ-12 | Structured Clinical Interview for DSM (SCID) | Center for Epidemiologic Studies-Depression Scale (CES-D) | GHQ-12 | 5 question screening instrument |
Exclusion criteria | Not stated | <18 years, non English speaking | Not stated | Not stated | Not stated | <18 years | Recent treatment for depression; psychoses; dementia; any other condition would interfere with the study objectives | < 18 years, not able to read English & consulting with GP other than index GP | Not stated |
Criteria for inclusion in cohort | Depressive disorders | Depressive symptoms | Three or more psychiatric symptoms on PSE | 192 patients with GHQ-30 scores = 4 & 55 with lower scores | Completion of GHQ | Major Depressive Episode & scored Montgomery-Åsberg Depression Rating Scale (MADRS) ≥ 20 | Major depression | GHQ ≥ 5, + those scoring GHQ 2–4 had a 30% probability & those scoring GHQ 0–1 had an 8% probability of selection. A random 50% of those not selected by GHQ but whom the GP had identified as having psychological problems were also selected | Non referred patients presenting with impairment due to anxiety or depression |
Measurement of depression at baseline | SADS | - | Present State Exam (PSE) | SADS-Lifetime Version | Clinical Interview Schedule (CIS) | SCID, Clinical Global Impression (CGI), MADRS | Composite International Diagnostic Interview (CIDI), CES-D | CIDI, Somatic and Psychological Health Report (SPHERE)-34 | SCID |
Cohort (% female) | 196 (% female not stated) | 1336 [Data presented on 942 (74% female) insured patients with complete follow ups] | 201 (64%–71% across onset groups) [Includes 20 participants with depression and 13 with borderline depression] | 247 at first interview [Paper reports only on 166 followed up (54% female)] | 305 (74%) [305 (74%) screened with GHQ in cross sectional study in 1997 (Kessler et al., 1999) [52% (157/305) GHQ +ve at screening, not clear from 2002 paper how many of the 157 were found again in 2002 paper] [60]] | 492 (72%) | 1117 (ranged across sites: 54–71%) | 908 (66%) | 108 (80%) [108 consecutive patients were prospectively evaluated, the paper does not state if this is the total number in cohort or those retained at follow up] |
Duration of follow-up | 12 months | 6 months | 3.5 years | 6 months | 3 years | 6 months | 12 months | 12 months | 8 months median follow up (Range 1–72 months) |
Other comorbidity measured | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Care received examined | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Definition of depression outcome | Loss of key symptoms & syndromal status + return to normal functioning for a minimum of 2 months | Not stated | No longer met criteria for baseline diagnosis | Remitted cases were those with positive SADS-L diagnosis at baseline but not at follow up | No longer case on GHQ-12 | Symptomatic exacerbation (MADRS score > 20) among patients who had responded to treatment but had not yet been well for a sufficient amount of time (under 6 months) | Complete remission from major depression | Results not yet available on outcome | Not stated |
Author | Michigan Depression Project [47, 49] | Parker et al. [68] | Ronalds et al. [37] | Rost et al. [67] | Rost et al. [38] | Schulberg et. [66] | Wagner et al. [42, 54] | WHO Collaborative Project on Psychological Problems in General Health Care [41,46,53,56,58,69,70] | |
Location | US | Australia | England | US | US | US | US | 15 centres in 14 countries [Countries included in the study are: India, Turkey, Greece, Germany, The Netherlands [55], Nigeria, UK, Japan, France, Brazil, Chile, US [57,70], China & Italy [36] | |
Primary care setting/s | Family physicians & University of Michigan, Department of Psychiatry Outpatient Depression Program | 12 General Practices | One General Practice with an attached psychiatric social worker, a visiting psychiatrist & a clinical psychologist at the health centre | 21 primary care practices | Using statewide telephone screening, identified and followed a cohort with a current major depression who made one or more visits to a primary care physician during the six months following baseline | One general medical clinic & two family practice clinics | One university-based family practice clinic | Health centre, primary health care unit, outpatient clinic, GP offices & private clinics, family practice, neighbourhood hospital & district hospital, primary care clinic | |
Selection of primary care setting | Not stated | Not stated | Not stated | Not stated | Not stated | Not stated | Not stated | Previous successful WHO collaboration, research experience in primary care, access to patient population | |
Recruitment | Waiting room | Consecutive patients | All surgery attenders | Consecutive patients | Statewide telephone screening, those who were depressed invited for telephone interview | Patients completed a depression screening instrument presented to them by receptionist | Patients introduced to RA by family physician at end of clinical visit | Consecutive patients | |
Screen for depression | CES-D | Beck Depression Inventory (BDI) | GHQ-28 | 3-item screen for major depression & dysthymia | Burnam screener | CES-D | CES-D | GHQ-12 | |
Exclusion criteria | Not stated | Inadequate knowledge of English, severely distressed & first time attenders | Not meeting DSM-III-R criteria for generalised anxiety, panic or depressive disorder | No access to a telephone | Bereaved, manic, acutely suicidal or denied depressive symptoms | Contact with clinics during the six months prior to index assessment | Being seen by the Duke Student Health Service, employees of the Department of Community & Family Medicine, or too ill physically | < 18 years, > 65 years, too ill, no fixed address, did not come for a medical consultation, communication problem, no consent | |
Criteria for inclusion in cohort | Major depression | BDI ≥ 10 | Met DSM-III-R criteria for general anxiety, panic or depressive disorder | Major depression | Major depression | CES-D ≥ 16 | CES-D ≥ 16 + random sample of CES-D <16 | Current psychiatric disorder at baseline diagnostic assessment & 20% random sample | |
Measurement of depression at baseline | SCID, CES-D, Hamilton Rating Scale for Depression (HAM-D) | past & current depression, PSE, Zung Depression Scale (ZDS) & 9 visual analogue scales | Psychiatric Assessment Schedule (PAS), Hamilton Depression Rating Scale (HDRS), Clinical Anxiety Scale (CAS) | Depression Outcome Module (DOS), Inventory to Diagnose Depression (IDD) | (Diagnostic Interview Schedule) DIS | DIS | DIS, CES-D | CIDI-Primary Health Care, GHQ-28 | |
Cohort (% female) | 81 from primary care (% not stated) | 35 (86%) | 182 with depressive, anxiety or panic disorder [Reports on 148 (67% female) followed up] | 47 (81%) | 162 (% not stated) | 294 (76%) | 213 (range 61–83% across depression categories) | 1174 (74%) | |
Duration of follow-up | 9 months | 20 weeks | 6 months | 5 months | 12 months | 6 months | 12 months | 12 months | |
Other comorbidity measured | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | |
Care received examined | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | |
Definition of depression outcome | Improvement in HAM-D score | improvement in Zung scores | Change in HDRS scores, changes in CAS scores & reduction in index of definition level | Remission from major depression | Remission: ≤ 2 of 9 DIS criteria for major depression met within last 2 weeks. | Resolution of major depressive disorder | Improvement i.e. moved to a less severe diagnostic category | Presence or absence of a depressive episode |