Many Patients With Depression Do Not Need a Psychiatrist

Primary care doctors can detect and treat most cases of depression, according to a study published in the July/August issue of the Annals of Family Medicine.

Manish K. Jha, M.D., from UT Southwestern Medical Center in Dallas, and colleagues retrospectively assessed the first 25,000 patients (aged ≥12 years) screened with the two-item Patient Health Questionnaire as part of the ongoing, VitalSign6 quality improvement project. Primary care physicians were given web-based software that guided them through protocols for screening patients for depression, prescribing treatments, and measuring their progress.

The researchers found that 4,325 patients (17.3 percent) screened positive for depression. Of these patients, 56.1 percent had clinician-diagnosed depressive disorder. Of the 2,160 depressed patients enrolled for ≥18 weeks, two-thirds (64.8 percent) were started on measurement-based pharmacotherapy and 6.4 percent were referred externally. For the 1,400 patients started on pharmacotherapy, one, two, and three or more follow-up visits occurred among 30.2, 12.6, and 11.6 percent of patients, respectively, while 45.5 percent had zero follow-up visits. For those with one, two, and three or more follow-up visits, remission rates were 20.3 percent (86 of 423), 31.6 percent (56 of 177), and 41.7 percent (68 of 163), respectively. Higher attrition was more common among patients who were nonwhite, had a positive drug-abuse screen, had lower depression/anxiety symptom severity, and were of younger age.

"This study shows that primary care physicians can do this, and do it well, with the right tools," a coauthor said in a statement.

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