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Table 2 Results

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]
Retention 72% (142/196) [Retention calculated from data presented in paper as not stated in results] 71% (942/1336) 77% (154/201) 67% (166/247) 59% (179/305) [Paper reports on 88 of original 157 GHQ +ve cases [60]] 86% (424/492) 87% (968/1117) [Data presented for 9 month follow up]
Recovery from/improvement in depression % not stated SCL-20 significantly reduced at 6 months (1.72 to 0.91, p < 0.001). Restricted activity days due to emotional health significantly reduced at 6 months (6.00 to 2.67 days, p < 0.001) 32% at 12 months & 47% at 3.5 years At 6 months, major depression was present in 33% of both the new & continuing case groups & in 16% of the remitted group 50% (16/32) of those not detected by a GP at baseline or during the 3 year follow up 65% (308/476) recovered without relapse, 25% (117/476) developed a chronic condition & 11% (51/476) relapsed after recovery 35% (340/968) complete remission (range 25%–48% across sites) [Data presented for 9 month follow up]
Predictors of outcome No data presented No data presented Positive life change increased the probability of remission in women fourfold (HR = 4.4), but not in men. Predictors of faster time to remission were low severity of pre-morbid difficulties (HR = 0.7), high self-esteem (HR = 1.4), and a coping style aimed at reducing tension (HR = 1.4) [32]. No data presented No data presented History of recurrent major depressive disorder was associated with a higher risk of relapse (OR 1.6, 95% CI 1.08–3.43) Education, key life events, & the Quality of Life Depression Scale score at baseline predicted complete remission after adjusting for centres, socio-demographic data, severity of depression, comorbidity & general quality of life [52]
Treatment 61% received no treatment during follow up & 29% received treatments of a type intensity & degree that would be considered "therapeutic" At follow up, 23% (219/942) of patients had been referred & 38% (356/942) had visited a mental health specialist. 54% visited a psychologist, 12% a psychiatrist & 34% visited both. Patients who saw a mental health specialist had more visits for depression to a primary physician than those who did not see a mental health specialist (1.93 [± SD 2.2] vs.0.98 [± SD 1.5]; p < 0.001) Recognition of psychiatric disorder by a GP among new cases resulted in greater likelihood of referral to a mental health specialist (OR 3.0), receiving psychotropic medications (OR 4.5), having a counseling session (OR 12.2) and having any mental health treatment (OR 6.7) [64]. Patients developing disorders between the first & second interview had the highest total ambulatory use, primary & specialty care of all types (9.23) [5.95 visits for no diagnosis group, 7.53 visits for remitted cases & 8.35 visits for continuing cases], while patients with continuing cases had the highest mean number of primary care visits (4.54) [3.19 visits for no diagnosis group, 3.35 visits for remitted cases & 3.28 visits for new cases] 68% (38/56) with diagnosis, were treated with antidepressants & 21% (12/56) were referred to psychiatric services All received an antidepressant treatment during the 6-month period. The total duration of treatment was <3 months for 41%, <30 days for 11%, between 30–60 days for 21%, & between 60–90 days for 9%. Duration of treatment was between 3–6 months for 14% of patients & ≥ 6 months for 45% of patients 0% (0%) in St Petersburg to 38% (33%) in Seattle received antidepressants (an effective dose) during follow up. 29% in Melbourne to 3% in St Petersburg received any specialty mental health care. The likelihood of receiving potentially effective antidepressant or mental health treatment at 3 months or 9 months did not differ across sites between the patients who were in complete remission & those who were not
Author Mental Health & General Practice Investigation (MaGPie) [63] Manning et al. [48] Michigan Depression Project [47, 49] Parker et al. [68] Ronalds et al. [37] Rost et al. [67] Rost et al. [38]
Retention 83% (753/908), 77% final magpie interview (696/908) 108 73% (59/81) of primary care patients [Data presented for 4.5 month follow up] 57% (20/35) 81% (148/182), 74 with major depressive disorder and 74 with generalized anxiety or panic disorders 81% (38/47) 94% (152/162) [Paper reports on 98 patients visiting a primary care physician ≥ 1 during 6 months following baseline]
Recovery from/improvement in depression No data presented No data presented Detected primary care patients failed to show significant improvement in HAM-D scores at 4.5 months. Both undetected primary care & detected psychiatric patients showed significant improvements over 4.5 months [By 9 months most patients in all 3 groups had improved & no longer met criteria for MDD [47]] 42.6 at baseline to 40.1 at follow up, indicating a 6% improvement Median HDRS score reduced from 12 (interquartile range 9–15) at baseline to 5 five (interquartile range 1–10) at follow up 32% (12/38) Remission: 36.9% of undetected patients and 29.2% of detected patients at 12 month follow up. Improvement: 10.2% of undetected patients and 9.8% of detected patients at 12 month follow up
Predictors of outcome No data presented No data presented No data presented Baseline predictors of a better outcome (improvement) were having a history of episodic or recurrent episodes; a more severe depression; lower social class; break up of an intimate relationship as a precipitant; a neutralizing life event & family support A reduction in social difficulties, high baseline HDRS score, higher educational level and current employment were associated with greater reduction in HDRS scores (adjusted R2 = 33.2%). Patients who received pharmacologic treatment concordant with guidelines between index visit & follow up were more likely to be in remission at follow up than subjects who did not (X2 = 3.8, p < 0.05) No data presented
Treatment In the year preceding the index consultation, 1/3 of male & 42% of female patients had five or more GP consultations Not purpose of paper In the past 6 months: 75% of detected & 9% of non-detected primary care patients had been prescribed medication, 88% & 29% respectively had been counseled by physician, 56% & 12% had been referred for counseling & 36% & 3% respectively had received individual or group therapy At follow up, 2 were still receiving antidepressant & 4 anxiolytic medication, while 3 were continuing to see their GP for depression In 93 patients the psychiatric disorder was recognised & managed as follows: 30 patients by discussion/counseling without drugs, 26 treated by GP with psychotropic drugs & 37 patients were referred to the specialist services. The greatest reduction in depression was in the patients managed without psychotropic drugs & referred to mental health services. 63% (24/38) filled prescriptions for one or more antidepressant medications between index visit & follow up. 29% (11/38) received pharmacologic treatment concordant with AHCPR guidelines. Two patients received 3 or more counseling sessions from a mental health professional. 52% of detected patients had a prescription for antidepressant medication during the year following baseline, 27% completed course in accordance with guidelines. 7% of detected patients received a referral from their primary care physician to a mental health specialist in addition to receiving a prescription for antidepressant medication.
Author 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] WHO Collaborative Project on Psychological Problems in General Health Care (Italy) [36] WHO Collaborative Project on Psychological Problems in General Health Care (US) [57,71] WHO Collaborative Project on Psychological Problems in General Health Care (Netherlands) [55]  
Retention 93% (274/294) 86% (184//213) 62% (729/1174) of patients with depressive episode     
Recovery from/improvement in depression 71% (12/17) 37% (19/51) of patients with major depression at baseline were asymptomatic at 12 months & 56% (37/66) of patients with minor depression at baseline were asymptomatic at 12 months [42] 67% (482/725) Of the 29 participants with baseline threshold major depression, 21% (n = 7) were well at 12 months & 14% (n = 4) were subthreshold At the 12-month assessment, 15/50 (30%) patients continued to satisfy criteria for major depressive disorder, 4/50 (8%) met criteria for minor depression, & 31/50 (62%) did not satisfy criteria for any depressive disorder At 12 months, 32% (21/66) of patients with a GP recognized ICD-10 diagnosis recovered (50% (33/66) improved) & 27% (21/79) patients whose ICD-10 diagnosis was not recognized by a GP recovered (47% (37/79) improved)  
Predictors of outcome Psychiatric status at initial assessment & the number of assigned medical diagnoses rather than the physicians recognition & treatment of depression strongly predict continued affective disorder Risk for persistent depression at 12 months for those with major depression at baseline was 44% greater in those with co-existing anxiety disorder (RR 1.44, 95% CI 1.02–2.04 [42] Less than 6 years formal education, unemployment, severity of depression, antidepressant use, repeated suicidal thoughts & abdominal pain as main reason for contacting GP were related to depression at follow up [41]. Comorbid generalised anxiety had a negative influence on the long-term course of depression in men (OR 2.66) but not women (OR = 0.52) [58]. At three month follow up, recognized patients reported a significantly greater reduction in GHQ scores than unrecognized patients (6.1 vs 4.1, F = 5.33, df = 1, p = 0.02), however by 12 month follow up there was no difference between recognized and unrecognized patients in change in GHQ score or change in diagnostic status from baseline. Patients with unrecognized and/or untreated depression showed rates of improvement similar to those of patients with recognized and/or treated depression [46]. Recognition of mental disorder by the physician at baseline was not associated with an improvement of psychopathology after 12 months, but was associated with an improvement in occupational disability & self-reported disability among threshold cases The likelihood of complete remission (no depressive diagnosis at 12-month follow-up) was 60% (21 of 35) for the recognized group & 68% (10 of 15) Patients whose psychological disorder was recognized had no better outcomes than those whose disorder was not recognized  
Treatment Among the 9 of 13 patients (depression not recognized by GP) whose depression remitted, 5 received no antidepressants, one received only 25 mg of Imipramine, 2 received an anti-anxiety drug & one received sleeping medications. 3 received psychiatric treatment at a psychiatric facility during the study period Odds for a visit to a mental health specialist or in the general medical sector for mental health purposes were significantly higher for respondents with a diagnosis of major depression relative to respondents with minor depression & significantly lower again for asymptomatic respondents, again relative to the minor depression group. In multivariate modeling, female gender, white race, & higher education was associated with higher odds of a mental health visit [54] Those depressed at follow-up were twice as likely to be taking antidepressants (20%) as non-depressed at follow- up (11%) Not presented Of patients with major depressive disorder (n = 64), pharmacy records showed that a total of 36 (56%) received antidepressant medications at some time during the 3 months following screening. Of them, 28 (78%) received dosages within the recommended ranges & 27 (75%) continued to refill antidepressant prescriptions for at least 90 days. Both dosage & duration of treatment met these standards in 22 (61%) of 36 cases. Among those with major depression, 39% (23/59) of visited at least one specialty mental health since screening. 66% (39/59) received some treatment during the 3 month follow up. Likelihood of receiving treatment was strongly related to severity of illness. Not presented