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Table 1 Methods

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]

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