|
Methods |
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| Author |
Blacker et al. [59] |
Grembowski et al. [51] |
Groningen Primary Care Study [32-35,50,64,65] |
Kessler et al. [61] |
Kessler et al. [45,60] |
Limosin et al. [43] |
Longitudinal investigation of depression outcomes in primary care (LIDO) [39,40, 44,52,62] |
Mental Health & General Practice Investigation (MaGPie) [63] |
Manning et al. [48] |
|
|
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| Location |
England |
US |
Netherlands |
US |
England |
France |
Israel, Brazil, Spain, Australia, Russia, US |
New Zealand |
US |
| Primary care setting/s |
One health centre |
261 primary physicians in private practice from 72 offices |
25 General Practitioners |
A multi-specialty group practice with 175 physicians |
One general practice |
560 General Practitioners |
6 research sites Primary care & outpatient services, day care services, & inpatient hospital services |
70 General Practitioners |
One private ambulatory family practice centre |
| Selection of primary care setting |
Not stated |
Consenting GPs from Physician Referral Study |
Representative sample |
Not stated |
Not stated |
Randomly selected |
Track record of international collaborative research |
Randomly selected |
Not stated |
| Recruitment |
Consecutive patients |
Waiting room |
Consecutive patients |
Patients who used clinic |
Consecutive patients |
Each GP enrolled first patient to meet criteria for major depressive episode |
Patients attending primary care facilities |
All adult attenders |
Consecutive non-referred patients presenting with impairment due to depression or anxiety |
| Screen for depression/mental health |
General Health Questionnaire (GHQ)-30, Schedule for Affective Disorders and Schizophrenia (SADS) |
Symptom Checklist (SCL) -20 |
GHQ-30 & rated by GP for current mental health problem |
GHQ-30 |
GHQ-12 |
Structured Clinical Interview for DSM (SCID) |
Center for Epidemiologic Studies-Depression Scale (CES-D) |
GHQ-12 |
5 question screening instrument |
| Exclusion criteria |
Not stated |
<18 years, non English speaking |
Not stated |
Not stated |
Not stated |
<18 years |
Recent treatment for depression; psychoses; dementia; any other condition would interfere with the study objectives |
< 18 years, not able to read English & consulting with GP other than index GP |
Not stated |
| Criteria for inclusion in cohort |
Depressive disorders |
Depressive symptoms |
Three or more psychiatric symptoms on PSE |
192 patients with GHQ-30 scores = 4 & 55 with lower scores |
Completion of GHQ |
Major Depressive Episode & scored Montgomery-Åsberg Depression Rating Scale (MADRS) ≥ 20 |
Major depression |
GHQ ≥ 5, + those scoring GHQ 2–4 had a 30% probability & those scoring GHQ 0–1 had an 8% probability of selection. A random 50% of those not selected by GHQ but whom the GP had identified as having psychological problems were also selected |
Non referred patients presenting with impairment due to anxiety or depression |
| Measurement of depression at baseline |
SADS |
- |
Present State Exam (PSE) |
SADS-Lifetime Version |
Clinical Interview Schedule (CIS) |
SCID, Clinical Global Impression (CGI), MADRS |
Composite International Diagnostic Interview (CIDI), CES-D |
CIDI, Somatic and Psychological Health Report (SPHERE)-34 |
SCID |
| Cohort (% female) |
196 (% female not stated) |
1336 [Data presented on 942 (74% female) insured patients with complete follow ups] |
201 (64%–71% across onset groups) [Includes 20 participants with depression and 13 with borderline depression] |
247 at first interview [Paper reports only on 166 followed up (54% female)] |
305 (74%) [305 (74%) screened with GHQ in cross sectional study in 1997 (Kessler et al., 1999) [52% (157/305) GHQ +ve at screening, not clear from 2002 paper how many of the 157 were found again in 2002 paper] [60]] |
492 (72%) |
1117 (ranged across sites: 54–71%) |
908 (66%) |
108 (80%) [108 consecutive patients were prospectively evaluated, the paper does not state if this is the total number in cohort or those retained at follow up] |
| Duration of follow-up |
12 months |
6 months |
3.5 years |
6 months |
3 years |
6 months |
12 months |
12 months |
8 months median follow up (Range 1–72 months) |
| Other comorbidity measured |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Care received examined |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Definition of depression outcome |
Loss of key symptoms & syndromal status + return to normal functioning for a minimum of 2 months |
Not stated |
No longer met criteria for baseline diagnosis |
Remitted cases were those with positive SADS-L diagnosis at baseline but not at follow up |
No longer case on GHQ-12 |
Symptomatic exacerbation (MADRS score > 20) among patients who had responded to treatment but had not yet been well for a sufficient amount of time (under 6 months) |
Complete remission from major depression |
Results not yet available on outcome |
Not stated |
| Author |
Michigan Depression Project [47, 49] |
Parker et al. [68] |
Ronalds et al. [37] |
Rost et al. [67] |
Rost et al. [38] |
Schulberg et. [66] |
Wagner et al. [42, 54] |
WHO Collaborative Project on Psychological Problems in General Health Care [41,46,53,56,58,69,70] |
|
| Location |
US |
Australia |
England |
US |
US |
US |
US |
15 centres in 14 countries [Countries included in the study are: India, Turkey, Greece, Germany, The Netherlands [55], Nigeria, UK, Japan, France, Brazil, Chile, US [57,70], China & Italy [36] |
|
| Primary care setting/s |
Family physicians & University of Michigan, Department of Psychiatry Outpatient Depression Program |
12 General Practices |
One General Practice with an attached psychiatric social worker, a visiting psychiatrist & a clinical psychologist at the health centre |
21 primary care practices |
Using statewide telephone screening, identified and followed a cohort with a current major depression who made one or more visits to a primary care physician during the six months following baseline |
One general medical clinic & two family practice clinics |
One university-based family practice clinic |
Health centre, primary health care unit, outpatient clinic, GP offices & private clinics, family practice, neighbourhood hospital & district hospital, primary care clinic |
|
| Selection of primary care setting |
Not stated |
Not stated |
Not stated |
Not stated |
Not stated |
Not stated |
Not stated |
Previous successful WHO collaboration, research experience in primary care, access to patient population |
|
| Recruitment |
Waiting room |
Consecutive patients |
All surgery attenders |
Consecutive patients |
Statewide telephone screening, those who were depressed invited for telephone interview |
Patients completed a depression screening instrument presented to them by receptionist |
Patients introduced to RA by family physician at end of clinical visit |
Consecutive patients |
|
| Screen for depression |
CES-D |
Beck Depression Inventory (BDI) |
GHQ-28 |
3-item screen for major depression & dysthymia |
Burnam screener |
CES-D |
CES-D |
GHQ-12 |
|
| Exclusion criteria |
Not stated |
Inadequate knowledge of English, severely distressed & first time attenders |
Not meeting DSM-III-R criteria for generalised anxiety, panic or depressive disorder |
No access to a telephone |
Bereaved, manic, acutely suicidal or denied depressive symptoms |
Contact with clinics during the six months prior to index assessment |
Being seen by the Duke Student Health Service, employees of the Department of Community & Family Medicine, or too ill physically |
< 18 years, > 65 years, too ill, no fixed address, did not come for a medical consultation, communication problem, no consent |
|
| Criteria for inclusion in cohort |
Major depression |
BDI ≥ 10 |
Met DSM-III-R criteria for general anxiety, panic or depressive disorder |
Major depression |
Major depression |
CES-D ≥ 16 |
CES-D ≥ 16 + random sample of CES-D <16 |
Current psychiatric disorder at baseline diagnostic assessment & 20% random sample |
|
| Measurement of depression at baseline |
SCID, CES-D, Hamilton Rating Scale for Depression (HAM-D) |
past & current depression, PSE, Zung Depression Scale (ZDS) & 9 visual analogue scales |
Psychiatric Assessment Schedule (PAS), Hamilton Depression Rating Scale (HDRS), Clinical Anxiety Scale (CAS) |
Depression Outcome Module (DOS), Inventory to Diagnose Depression (IDD) |
(Diagnostic Interview Schedule) DIS |
DIS |
DIS, CES-D |
CIDI-Primary Health Care, GHQ-28 |
|
| Cohort (% female) |
81 from primary care (% not stated) |
35 (86%) |
182 with depressive, anxiety or panic disorder [Reports on 148 (67% female) followed up] |
47 (81%) |
162 (% not stated) |
294 (76%) |
213 (range 61–83% across depression categories) |
1174 (74%) |
|
| Duration of follow-up |
9 months |
20 weeks |
6 months |
5 months |
12 months |
6 months |
12 months |
12 months |
|
| Other comorbidity measured |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
|
| Care received examined |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
|
| Definition of depression outcome |
Improvement in HAM-D score |
improvement in Zung scores |
Change in HDRS scores, changes in CAS scores & reduction in index of definition level |
Remission from major depression |
Remission: ≤ 2 of 9 DIS criteria for major depression met within last 2 weeks. |
Resolution of major depressive disorder |
Improvement i.e. moved to a less severe diagnostic category |
Presence or absence of a depressive episode |
|
Gilchrist and Gunn BMC Family Practice 2007 8:28 doi:10.1186/1471-2296-8-28 |
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