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Table 1 Methods

From: Observational studies of depression in primary care: what do we know?

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]
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