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Open Access Research article

Referral of patients with depression to mental health care by Dutch general practitioners: an observational study

Ellen Piek1*, Klaas van der Meer1, Brenda WJH Penninx234, Peter FM Verhaak15 and Willem A Nolen2

Author Affiliations

1 Department of General Practice, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Postbus 196, 9700 AD Groningen, The Netherlands

2 Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30.001, 9700 RB Groningen, The Netherlands

3 Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, AJ Ernststraat 887, 1081 HL Amsterdam, The Netherlands

4 Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

5 Netherlands Institute for Health Services Research, Utrecht, The Netherlands

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BMC Family Practice 2011, 12:41  doi:10.1186/1471-2296-12-41

Published: 26 May 2011



Depression is a common illness, often treated in primary care. Guidelines provide recommendations for referral to mental health care. Several studies investigated determinants of referral, none investigated guideline criteria as possible determinants.

We wanted to evaluate general practitioner's referral of depressed patients to mental health care and to what extent this is in agreement with (Dutch) guideline recommendations.


We used data of primary care respondents from the Netherlands Study of Depression and Anxiety with major depressive disorder in the past year (n = 478). We excluded respondents with missing data (n = 134). Referral data was collected from electronic patient files between 1 year before and after baseline and self report at baseline and 1-year follow-up. Logistic regression was used to describe association between guideline referral criteria (e.g. perceived need for psychotherapy, suicide risk, severe/chronic depression, antidepressant therapy failure) and referral.


A high 58% of depressed patients were referred. Younger patients, those with suicidal tendency, chronic depression or perceived need for psychotherapy were referred more often. Patients who had used ≥2 antidepressants or with chronic depression were more often referred to secondary care. Referred respondents met on average more guideline criteria for referral. However, only 8-11% of variance was explained.


The majority of depressed patients were referred to mental health care. General practitioners take guideline criteria into account in decision making for referral of depressed patients to mental health care. However, other factors play a part, considering the small percentage of variance explained. Further research is necessary to investigate this.