Research article
Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study
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* Corresponding author: Peter FM Verhaak p.verhaak@nivel.nl
1 NIVEL, Netherlands Institute for Health Services Research, (Postbus 1568), Utrecht, (3500 BN), the Netherlands
2 Dep. of General Practice, University Medical Centre Groningen, (Postbus 30001), Groningen (9700 RB), the Netherlands
3 Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, (Postbus 9101, 114) Nijmegen, (6500 HB) the Netherlands
4 Department of General Practice, VU University Medical Center, (Postbus 7057), Amsterdam (1007 MB), the Netherlands
5 Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, VU University Medical Center, (A.J. Ernststraat 887) Amsterdam, 1081 HL the Netherlands
6 Department of Psychiatry, Leiden University Medical Center, (Postbus 9600), Leiden, (2300 RC), the Netherlands
7 Department of Psychiatry, University Medical Center Groningen, (Postbus 11120), Groningen, (9700 CC), the Netherlands
8 Department of Clinical and Health Psychology, Utrecht University, (Postbus 80140), Utrecht, (3508 TC), the Netherlands
BMC Psychiatry 2011, 11:180 doi:10.1186/1471-244X-11-180
Published: 18 November 2011Abstract
Background
There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general practice patients with depression and anxiety, and identify patient and treatment characteristics associated with clinical improvement.
Methods
This study forms part of the Netherlands Study of Depression and Anxiety (NESDA).
Adult patients, recruited in general practice (67 GPs), were interviewed to assess DSM-IV diagnoses during baseline assessment of NESDA, and also completed questionnaires measuring symptom severity, received care, socio-demographic variables and social support both at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care received. Information on guideline adherence was obtained from GP medical records.
Results
721 patients with a current (6-month recency) anxiety or depressive disorder participated. While patients who received guideline concordant care (N = 281) suffered from more severe symptoms than patients who received non-guideline concordant care (N = 440), both groups showed equal improvement in their depressive or anxiety symptoms after 12 months. Patients who (still) had moderate or severe symptoms at follow-up, were more often unemployed, had smaller personal networks and more severe depressive symptoms at baseline than patients with mild symptoms at follow-up. The particular type of treatment followed made no difference to clinical outcomes.
Conclusion
The added value of guideline concordant care could not be demonstrated in this study. Symptom severity, employment status, social support and comorbidity of anxiety and depression all play a role in poor clinical outcomes.