Diagnostic accuracy and treatment approach to depression in primary care: predictive factors
Por:
Aznar I, Iglesias M, Rubio-Valera M, Peñarrubia-María MT, Mendive JM, Murrugarra-Centurión AG, Gil MM, González Suñer L, Peuters C and Serrano-Blanco A
Publicada:
1 feb 2019
Ahead of Print:
12 nov 2018
Categoría:
Family practice
Resumen:
Objective The study assessed the predictive factors of diagnostic accuracy and treatment approach (antidepressants versus active monitoring) for depression in primary care.
Methods This is a cross-sectional study that uses information from a naturalistic prospective controlled trial performed in Barcelona (Spain) enrolling newly diagnosed patients with mild to moderate depression by GPs. Treatment approach was based on clinical judgement. Diagnosis was later assessed according to DSM-IV criteria using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview by an external researcher. Patients (sociodemographic, psychiatric diagnosis, severity of depression and anxiety, health-related quality of life, disability, beliefs about medication and illness and comorbidities) and GP factors associated with diagnostic accuracy and treatment approach were assessed using multilevel logistic regression. Variables with missing data were imputed through multiple imputations.
Results Two hundred sixty-three patients were recruited by 53 GPs. Mean age was 51 years (SD = 15). Thirty percent met DSM-IV criteria for major depression. Mean depression symptomatology was moderate-severe. Using multivariate analyses, patients' beliefs about medicines were the only variable associated with the antidepressant approach. Specialization in general medicine and being a resident tutor were associated with a more accurate diagnosis.
Conclusions Clinical depression diagnosis by GPs was not always associated with a formal diagnosis through a SCID-I. GPs' training background was central to an adequate depression diagnosis. Patients' beliefs in medication were the only factor associated with treatment approach. More resources should be allocated to improving the diagnosis of depression.
Filiaciones:
Aznar I:
Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
Iglesias M:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
School of Medicine, University of Barcelona, Barcelona, Spain
Rubio-Valera M:
Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
Peñarrubia-María MT:
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut, Catalonia, Spain
Mendive JM:
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Spain
:
Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
Gil MM:
Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
González Suñer L:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
Peuters C:
Department of Movement and Sports Sciences, Ghent University, Belgium
Serrano-Blanco A:
Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
School of Medicine, University of Barcelona, Barcelona, Spain
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