Department of General Practice, University Medical Center Groningen, University of Groningen, Postbox 196, 9700 AD Groningen, The Netherlands.
J Affect Disord. 2012 May;138(3):397-404. doi: 10.1016/j.jad.2012.01.006. Epub 2012 Feb 19.
Although most depressed patients are treated in primary care, not all are recognized as such. This study explores the determinants of (non-)recognition of depression by general practitioners (GPs), with a focus on specific depression symptoms as possible determinants.
Recognition of depression by GPs was investigated in 484 primary care participants of the Netherlands Study of Depression and Anxiety, with a DSM-IV diagnosis of depression in the past year. Recognition (yes/no) by GPs was based on medical file extractions (GP diagnosis of depressive symptoms/depressive disorder and/or use of antidepressants/referral to mental health care). Potential determinants of (non-)recognition (patient, depression, patient-GP interaction, and GP characteristics) were bivariately tested and variables with a p-value ≤0.2 entered into a multilevel multivariate model. Subgroup analysis was performed on 361 respondents with more reliable GP diagnosis data.
60.5% of patients were recognized by their GP. Patients who did not consult their GP for mental problems, and without comorbid anxiety disorder(s) were less often recognized. In the subgroup, where 68.7% was recognized, in addition to these, decreasing number of symptoms of depression and increased appetite were associated with decreased recognition. No GP characteristics were retained in the final model.
Some data on recognition were collected retrospectively.
In addition to patients without a comorbid anxiety disorder or who did not consult their GP for mental problems, GPs less often recognized patients with fewer depression symptoms or with increased appetite. Recognition may be improved by informing/teaching GPs that also increased appetite can be a symptom of depression.
尽管大多数抑郁患者在初级保健机构接受治疗，但并非所有患者都能得到识别。本研究探讨了全科医生（GP）识别抑郁的决定因素，重点关注特定抑郁症状作为可能的决定因素。
在荷兰抑郁和焦虑研究的 484 名初级保健参与者中，调查了 GP 对抑郁的识别情况，这些参与者在过去一年中都有 DSM-IV 诊断的抑郁。GP 的识别（是/否）是基于医疗记录的提取（GP 对抑郁症状/抑郁障碍的诊断以及/或使用抗抑郁药/转介到精神保健）。（非）识别的潜在决定因素（患者、抑郁、患者-GP 互动和 GP 特征）进行了双变量测试，p 值≤0.2 的变量被纳入多水平多变量模型。对有更可靠 GP 诊断数据的 361 名受访者进行了亚组分析。
60.5%的患者被 GP 识别。那些不向 GP 咨询精神问题且没有共病焦虑障碍的患者不太可能被识别。在亚组中，有 68.7%的患者被识别，除此之外，抑郁症状减少和食欲增加与识别率降低相关。在最终模型中没有保留任何 GP 特征。
关于识别的一些数据是回顾性收集的。
除了没有共病焦虑障碍或不向 GP 咨询精神问题的患者外，GP 还较少识别出抑郁症状较少或食欲增加的患者。通过告知/教授 GP 增加的食欲也可能是抑郁的症状，可能会提高识别率。
