Herkenning van depressie door de huisarts

Objective

To investigate the influence of recognition of depression in the GP’s practice on outcome at 6, 12 and 39 months.

Design

Prospective cohort study.

Methods

A total of 1293 patients from GP’s practices were included in the ‘PREDICT-NL’ study (part of an international prospective cohort study (PredictD)). Follow-up assessments were performed at 6 (n = 1236), 12 (n = 1179), and 39 (n = 752) months. The diagnosis ‘depression’ was made in accordance with DSM-IV criteria during a structured interview (‘Composite International Diagnostic Interview’ (CIDI)). Symptoms of depression were investigated using the ‘Patient Health Questionnaire 9’ (PHQ-9) and mental functional status was measured using the Mental Component Summary (MCS) of the ‘Short-Form 12’. Diagnosis and treatment of depression by the General Practitioner was assessed on the basis of electronic patient dossiers and ‘International Classification of Primary Care’ (ICPC) codes (P03 and P76) and ‘Anatomical Therapeutic Chemical’ (ATC) codes (N06A).

Results

Depression was diagnosed in 170 (13%) of the participants at the start of the study; 36% of cases were recognised by the GP. The risk of being depressed at 39 months was 1.4 times as high (95% CI: 0.68-2.68) for participants with recognised depression compared with unrecognised depression. At the start of the study, participants with recognised depression had more depressive symptoms (mean difference PHQ-9 score: 2.7, 95% CI: 1.6-3.9) and worse mental functional status (mean difference in MCS score: -3.8, 95% CI: -7.8-0.2) than participants with unrecognised depression. At 12 and 39 months mean scores for both groups did not differ.

Conclusion

A minority of patients with depression are recognised in the GP’s practice. There was no difference in symptoms of depression and mental functional status at 12 and 39 months between patients with recognised and non-recognised depression, which suggests that recognition of depression does not influence long-term outcome.

Conflict of interest: the institute for which N. de Wit works received funding for studies of irritable bowel syndrome (the Netherlands institute for health research and development ‘ZonMw’ Everyday Illnesses, European Society for Primary Care Gastroenterology) and for organic and non-organic abdominal symptoms (ZonMw Efficiency), and for the research projects ‘Efficiency and prevention’ and ‘On the same line’ (ZonMw). Financial support: this study was financed by the European Commission’s Fifth Framework (Grant number PREDICT-QL4-CT2002-00683) and by the Netherlands Organisation for Scientific Research (NWO) (Project number 917-66-311).