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Open Access Research article

Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

Weng Yee Chin1*, Kit TY Chan1, Cindy LK Lam1, Samuel YS Wong2, Daniel YT Fong3, Yvonne YC Lo4, Tai Pong Lam1 and Billy CF Chiu5

Author Affiliations

1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China

2 Division of Family Medicine and Primary Health Care, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China

3 School of Nursing, The University of Hong Kong, Hong Kong, China

4 Department of Family Medicine, Hong Kong West Cluster, Hospital Authority, Hong Kong, China

5 Family Medicine and Primary Care Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China

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BMC Family Practice 2014, 15:30  doi:10.1186/1471-2296-15-30

Published: 12 February 2014

Abstract

Background

This study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong.

Methods

A cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management.

Results

10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.

In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor.

Conclusion

About one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.

Keywords:
Mental health; Chinese; Depression; Epidemiology; Primary care; Prevalence; Screening; Detection; Practice-based research network