Management of major depression in the primary care setting.
BACKGROUND
Patients treated in community clinics, particularly those of minority status, may rely more heavily on primary care physicians (PCPs) for the diagnosis and management of depression. We wished to determine how PCPs in a community clinic setting initially manage patients newly diagnosed with major depression.


METHODS
698 patients were screened for major depression by the Structural Clinical Interview for DSM-III-R in a community-based primary care health center. Forty outpatients (29 Hispanic) were found to suffer from major depression. A letter explaining positive findings was sent to the patients' PCPs. Medical record charts were reviewed 3 months later to determine the PCP's management following the diagnosis.


RESULTS
Of the 38 patients who remained in the study at 3 months, 20 (53%) received no intervention from the PCP by the end of 3 months after diagnosis, and of these, 14 were Hispanic. Five (13%) were prescribed an antidepressant by the PCP. Nine (24%) were referred to mental health services for medication, psychotherapy or combination treatment. Four (11%) were prescribed an antidepressant and then referred to mental health services. Differences between management of Hispanic and non-Hispanic patients were not statistically significant.


CONCLUSIONS
Independent screening by psychiatrists in primary care settings may not be adequate enough to ensure appropriate management of depression by PCPs. Possible explanations may include time constraints during primary care visits, patient and/or physician reticence, and insufficient education of PCPs about depression.
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA., USA. dmischoulon@partners.org
D
D
Mischoulon
R
R
McColl-Vuolo
S
S
Howarth
I T
IT
Lagomasino
J E
JE
Alpert
A A
AA
Nierenberg
M
M
Fava
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D014481:United States
D000928:Antidepressive Agents