Graham,
You wanted UK references? There are some US ones at the end too,
Iain
Should general practitioners be testing for depression?
In: Br J Gen Pract (1994 Mar) 44(380):132-5
While most patients with recognised depressive illness are treated by
general practitioners without referral, there is evidence that many
patients classifiable as depressed after psychiatric interview are
not diagnosed as such. Missing depression is of great importance
since it is now eminently treatable. This paper explores the use in
primary care of questionnaire tests for depression and also their
role in case finding in vulnerable groups of patients.
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Scott J Moon CA Blacker CV Thomas JM
A. I. F. Scott & C. P. L. Freeman's "Edinburgh Primary Care
Depression Study.
In: Br J Psychiatry (1994 Mar) 164(3):410-5
"#OBJECTIVE--To compare the clinical efficacy, patient satisfaction,
and cost of three specialist treatments for depressive illness with
routine care by general practitioners in primary care.
RESULTS--Marked improvement in depressive symptoms occurred in all
treatment groups over 16 weeks. Any clinical advantage of specialist
treatments over routine general practitioner care were small, but
specialist treatment involved at least four times as much therapist
contact and cost at least twice as much as routine general
practitioner care. Psychological treatments, especially social work
counselling, were most positively evaluated by patients. CONCLUSIONS--
The additional costs associated with specialist treatments of new
episodes of mild to moderate depressive illness presenting in primary
care were not commensurate with their clinical superiority over
routine general practitioner care. A proper cost-benefit analysis
requires information about the ability of specialist treatment to
prevent future episodes of depression.
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Sireling LI Paykel ES Freeling P Rao BM Patel SP
Depression in general practice: case thresholds and diagnosis.
In: Br J Psychiatry (1985 Aug) 147:113-9
Using multiple diagnostic and epidemiological criteria, three samples
of general practice (GP) depressives were studied: those prescribed a
new course of antidepressants, those given other treatment, and those
missed by the GP. The majority of patients qualified as psychiatric
cases on the PSE Index of Definition, the Bedford College Criteria,
and the Research Diagnostic Criteria. Most satisfied diagnostic
criteria for depression, or (fewer) anxiety. The disorders were
relatively mild and often borderline on all three systems.
Depressives given other treatment most often failed to meet
diagnostic criteria. About half the antidepressant treated patients
received RDC diagnoses of major depression. Among the other treatment
sample, only one-fifth met these criteria, and half had non-
depressive diagnoses. Most cases of depression treated by GPs satisfy
criteria for psychiatric disorder, but tend to be relatively mild and
borderline in quality.
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MacDonald AJ
Do general practitioners "miss" depression in elderly patients?
In: Br Med J (Clin Res Ed) (1986 May 24) 292(6532):1365-7
In a study of the prevalence of depression in 235 elderly patients
who attended general practice surgeries less than 12% of the
disagreement between the research assessment of depression and the
general practitioner's assessment was due to "missed" depression.
There were, however, low rates of referral and of treatment with
antidepressant drugs. If these findings are confirmed the study of
the management and outcome of depression in such patients may be more
rewarding than attempts to improve the recognition of depression.
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Depression in medical outpatients. Underrecognition and misdiagnosis
In: Arch Intern Med (1990 May) 150(5):1083-8
Depression is a common problem in medical outpatients, yet primary
care physicians recognizee the disorder in only about half of their
depressed patients. We compared physician recognition of depression....
We conclude that physicians underscoring....depression in medical
outpatients.
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Prevalence and recognition of depression among primary care
outpatients.
In: J Fam Pract (1987 Jul) 25(1):67-72
Studies indicate that more individuals suffering from depressive
symptoms will present to the primary care outpatient clinic than to
any other medical care setting. Unfortunately, most of these patients
complain of somatic problems, not mood disturbances. Consequently,
less than one half of all depressed patients in the primary care
clinic are initially identified and treated for their depression. As
inappropriate treatment, and avoiding substantial suffering. The
threshold for many somatic complaints can be substantially raised
with resolution of depression.
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Reifler BV Okimoto JT Heidrich FE Inui TS
Recognition of depression in a university-based family medicine
residency program.
In: J Fam Pract (1979 Oct) 9(4):623-8
The authors suggest that if a
primary care physician diagnoses depression in less than 2 percent of
patient encounters, he or she should consider the possibility of
missed diagnoses.
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Gerber PD Barrett JE Barrett JA Oxman TE Manheimer E Smith R
Whiting RD
The relationship of presenting physical complaints to depressive
symptoms in primary care patients.
In: J Gen Intern Med (1992 Mar-Apr) 7(2):170-3
OBJECTIVE: To assess the relationship of specific patient chief
physical complaints to underlying depressive symptoms in primary care
practice. CONCLUSIONS: Depressed patients are
common in primary care practice and important but difficult to
recognizee.
Certain specific complaints and complaint presentation styles are
associated
with underlying depressive symptoms.
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Gerber PD Barrett J Barrett J Manheimer E Whiting R Smith R
Recognition of depression by internists in primary care: a comparison
of internist and "gold standard" psychiatric assessments.
In: J Gen Intern Med (1989 Jan-Feb) 4(1):7-13
In an effort to elucidate the process of internists' recognition of
depression in primary care settings, a comparison of internist and
"gold standard" psychiatric assessments of patients was undertaken in
a rural primary care practice over a 15-month period. Clinical
characteristics and diagnoses, global assessments of psychosocial
stress, and two aspects of chief-complaint presentation style,
clarity and somatization, were recorded by the internists for each
patient, who was independently assessed by a psychiatrist for the
presence of any specific depressive disorder by structured interview.
Internists correctly labelled 57% of the interview-assessed
depressives as depressed; 13% of patients with "no psychiatric
disorder" were assessed as depressed by internists. Clinical and
demographic characteristics of the "false-negative" and "false-
positive" internists' diagnoses were examined to clarify how
internists think of "depression" in the primary care context.
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