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Villanueva V, Artal J, Cabeza-Alvarez CI, Campos D, Castillo A, Flórez G, Franco-Martin M, García-Portilla MP, Giráldez BG, Gotor F, Gutiérrez-Rojas L, Albanell AM, Paniagua G, Pintor L, Poza JJ, Rubio-Granero T, Toledo M, Tortosa-Conesa D, Rodríguez-Uranga J, Bobes J. Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus. Neurol Ther 2023; 12:479-503. [PMID: 36692706 PMCID: PMC10043101 DOI: 10.1007/s40120-023-00437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE. METHODS This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations. RESULTS Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide. CONCLUSION We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.
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Affiliation(s)
- Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Jesús Artal
- Psychiatry Department, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Spain.
| | | | - Dulce Campos
- Neurology Department, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Ascensión Castillo
- Neurology Department, Consorcio Hospital General Universitario Valencia, Valencia, Spain
| | - Gerardo Flórez
- Psychiatry Department, Addiction Treatment Unit, Orense, Spain
| | - Manuel Franco-Martin
- Psychiatry Department, Zamora Hospital (Complejo Asistencial de Zamora), Zamora, Spain
| | - María Paz García-Portilla
- Psychiatry Department, University of Oviedo, ISPA, CIBERSAM, INEUROPA, and Mental Health Services of Principality of Asturias, Oviedo, Spain
| | - Beatriz G Giráldez
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francisco Gotor
- Psychiatry Department, School of Medicine, University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - Gonzalo Paniagua
- Psychiatry Department, University of Oviedo, Oviedo, Spain.,Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Luis Pintor
- Psychiatry Department, Hospital Clínico of Barcelona, Barcelona, Spain
| | - Juan José Poza
- Neurology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Teresa Rubio-Granero
- Psychiatry Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Toledo
- Epilepsy Unit, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Diego Tortosa-Conesa
- Neurology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Julio Bobes
- Medicine-Psychiatry, Universidad de Oviedo, Oviedo, Spain
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Abstract
BACKGROUND In the light of high incidences of diagnosed mental disorders and the growing utilization of mental healthcare services, a progressing psychiatrization of society has been hypothesized as the underlying dynamic of these developments. Mental healthcare institutions, such as psychiatric hospitals, may play a decisive role in this. However, there is a scarcity of research into how psychiatrization emerges in hospital settings. This paper explores whether the emergency department (ED) can be considered as a site where psychiatrization happens, becomes observable, and which factors in the context of the ED may be its potential drivers. METHODS Two cases as encountered in an interdisciplinary ED will be presented in the following in an anonymized way. Although the cases originate from individual consultations, they can be considered as prototypical. The cases were collected and discussed using the method of interactive interviewing. The results will be analyzed against the backdrop of current theoretic concepts of psychiatrization. FINDINGS The ED can be seen as an important area of contact between society and psychiatry. Decisions whether to label a certain condition as a "mental disorder" and to therefore initiate psychiatric treatment, or not, can be highly difficult, especially in cases where the (health) concerns are rather moderate, and clearly associated with common life problems. Psychiatrists' decisions may be largely influenced in favor of psychiatrization by a wide array of disciplinary, institutional, interpersonal, personal, cultural, and social factors. CONCLUSIONS The ED appears to be a promising field for research into the mechanisms and motives through which psychiatrization may emerge in mental healthcare settings. Psychiatrists in the ED work within a complex sphere of top-down and bottom-up drivers of psychiatrization. Encounters in the ED can be an important step toward adequate support for many individuals, but they also risk becoming the starting point of psychiatrization by interpreting certain problems through the psychiatric gaze, which may induce diagnoses of questionable validity and treatment of little use.
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Tuffour I. Let's talk about the negative experiences of Black mental health service users in England: Now is the moment to consider watchful waiting to support their recovery. Nurs Inq 2021; 29:e12484. [DOI: 10.1111/nin.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Isaac Tuffour
- School of Nursing, Faculty of Education, Health, and Wellbeing University of Wolverhampton Wolverhampton UK
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Iglesias-González M, Gil-Girbau M, Peñarrubia-María MT, Blanco-García E, Fernández-Vergel R, Serrano-Blanco A, Carbonell-Duacastella C, Alonso J, Rubio-Valera M. Barriers and opportunities for the treatment of mild-to-moderate depression with a watchful waiting approach. Patient Educ Couns 2021; 104:611-619. [PMID: 32782178 DOI: 10.1016/j.pec.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/17/2020] [Accepted: 07/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs). METHODS Qualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented. RESULTS The results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients' preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services. CONCLUSION Based on FPs' perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients' preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals. PRACTICE IMPLICATIONS Resources for education, structural support in PC and modified back up from mental healthcare services are needed.
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Affiliation(s)
- M Iglesias-González
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - M Gil-Girbau
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - M T Peñarrubia-María
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain; SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
| | - E Blanco-García
- Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain; SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
| | - R Fernández-Vergel
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain; Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain; SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
| | - A Serrano-Blanco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - C Carbonell-Duacastella
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - J Alonso
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - M Rubio-Valera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.
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Rubio-Valera M, Peñarrubia-María MT, Iglesias-González M, Knapp M, McCrone P, Roig M, Sabes-Figuera R, Luciano JV, Mendive JM, Murrugara-Centurión AG, Alonso J, Serrano-Blanco A. Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study). Eur J Health Econ 2019; 20:703-713. [PMID: 30725226 DOI: 10.1007/s10198-019-01034-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild-moderate major depressive disorder. METHODS This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners' clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost-utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. RESULTS At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). CONCLUSIONS Incremental cost-utility ratios favor pharmacological treatment as a first-line approach for patients with mild-moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild-moderate major depressive patients as an alternative to active monitoring in PC.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain.
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain.
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
| | - María Teresa Peñarrubia-María
- Primary Care Health Centre Bartomeu Fabrés Anglada, Servei d'Atenció Primària Delta Llobregat, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain
| | - Maria Iglesias-González
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
| | - Martin Knapp
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK
| | - Paul McCrone
- Institute of Psychiatry, King's College London, De Crespigny Park, London, UK
| | - Marta Roig
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain
| | - Ramón Sabes-Figuera
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan V Luciano
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- Open University of Catalonia (UOC), Barcelona, Spain
| | - Juan M Mendive
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Barcelona, Spain
| | - Ana Gabriela Murrugara-Centurión
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
| | - Jordi Alonso
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
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Braillon A, Lexchin J, Noble JH, Menkes D, M'sahli L, Fierlbeck K, Blumsohn A, Naudet F. Challenging the promotion of antidepressants for nonsevere depression. Acta Psychiatr Scand 2019; 139:294-295. [PMID: 30697690 DOI: 10.1111/acps.13010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - J Lexchin
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - J H Noble
- State University of New York at Buffalo, Georgetown, TX, USA
| | - D Menkes
- Waikato Clinical Campus, University of Auckland, Auckland, New Zealand
| | - L M'sahli
- Council of the National Anti-Corruption Authority (INLUCC), Tunis, Tunisia
| | - K Fierlbeck
- Department of Political Science, Dalhousie University, Halifax, NS, Canada
| | | | - F Naudet
- INSERM CIC-P 1414 and University Hospital, Rennes, France
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Dannenberg MD, Bienvenida JCM, Bruce ML, Nguyen T, Hinn M, Matthews J, Bartels SJ, Elwyn G, Barr PJ. End-user views of an electronic encounter decision aid linked to routine depression screening. Patient Educ Couns 2019; 102:555-563. [PMID: 30497800 DOI: 10.1016/j.pec.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/10/2018] [Accepted: 10/01/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Our aim was to gather community stakeholder input to inform the development of a digital system linking depression screening to decision support. METHODS Views and feature requirements were identified through (1) focus groups with patients and consumers with depression, and interviews with primary care clinicians and (2) usability sessions where patients and consumers used the current version of encounter decision aid (eDA) in a primary care waiting room. Qualitative data were analyzed using the framework method. RESULTS We conducted six focus groups with 15 participants, seven clinician interviews and 10 usability sessions. Patients were comfortable completing the Patient Health Questionnaire (PHQ-9) and receiving the electronic eDA in clinic. They felt this would allow patients to prepare for their visit and instill a sense of agency. Participants were comfortable receiving the PHQ-9 results and a subsequent eDA on a tablet in the waiting room. CONCLUSION Patients with and without depression, as well as clinicians, viewed linking the PHQ-9, results, and eDA positively. Patients were comfortable doing this in the clinic waiting room. PRACTICE IMPLICATIONS Linking depression decision support to screening was viewed positively by patients and clinicians, and could help overcome barriers to shared decision-making implementation in this population.
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Affiliation(s)
- Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth Lebanon, New Hampshire, USA
| | - John Carlo M Bienvenida
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth Lebanon, New Hampshire, USA
| | - Martha L Bruce
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth Lebanon, New Hampshire, USA; Departments of Psychiatry and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | | | | | - Stephen J Bartels
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth Lebanon, New Hampshire, USA; Departments of Psychiatry and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth Lebanon, New Hampshire, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth Lebanon, New Hampshire, USA.
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Braillon A, Taiebi F. [Benzodiazépines misuse and limited access to cognitive-behavioral therapy. Letter on the special issue: "All the truth about benzodiazépines"]. Presse Med 2019; 48:215-216. [PMID: 30799149 DOI: 10.1016/j.lpm.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/29/2022] Open
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9
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Aznar-Lou I, Iglesias-González M, Rubio-Valera M, Peñarrubia-Maria MT, Mendive JM, Murrugarra-Centurión AG, Gil-Girbau M, González-Suñer L, Peuters C, Serrano-Blanco A. Diagnostic accuracy and treatment approach to depression in primary care: predictive factors. Fam Pract 2019; 36:3-11. [PMID: 30423158 DOI: 10.1093/fampra/cmy098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The study assessed the predictive factors of diagnostic accuracy and treatment approach (antidepressants versus active monitoring) for depression in primary care. METHODS This is a cross-sectional study that uses information from a naturalistic prospective controlled trial performed in Barcelona (Spain) enrolling newly diagnosed patients with mild to moderate depression by GPs. Treatment approach was based on clinical judgement. Diagnosis was later assessed according to DSM-IV criteria using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview by an external researcher. Patients (sociodemographic, psychiatric diagnosis, severity of depression and anxiety, health-related quality of life, disability, beliefs about medication and illness and comorbidities) and GP factors associated with diagnostic accuracy and treatment approach were assessed using multilevel logistic regression. Variables with missing data were imputed through multiple imputations. RESULTS Two hundred sixty-three patients were recruited by 53 GPs. Mean age was 51 years (SD = 15). Thirty percent met DSM-IV criteria for major depression. Mean depression symptomatology was moderate-severe. Using multivariate analyses, patients' beliefs about medicines were the only variable associated with the antidepressant approach. Specialization in general medicine and being a resident tutor were associated with a more accurate diagnosis. CONCLUSIONS Clinical depression diagnosis by GPs was not always associated with a formal diagnosis through a SCID-I. GPs' training background was central to an adequate depression diagnosis. Patients' beliefs in medication were the only factor associated with treatment approach. More resources should be allocated to improving the diagnosis of depression.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
| | - Maria Iglesias-González
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Rubio-Valera
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - M Teresa Peñarrubia-Maria
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut, Catalonia, Spain
| | - Juan M Mendive
- Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Spain
| | - Ana G Murrugarra-Centurión
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Montserrat Gil-Girbau
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | | | - Carmen Peuters
- Department of Movement and Sports Sciences, Ghent University, Belgium
| | - Antoni Serrano-Blanco
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
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