The identification of depression and the coverage of antidepressant drug prescriptions in Italian general practice.
BACKGROUND
Studies on antidepressant prescriptions in general practice need to assess the level of prescriptions relative to the need for them ('coverage'), and the variability among doctors.


METHODS
Two different cut-off scores on a screening test for depression (the Personal Health Questionnaire, PHQ) are used to predict rates for depression, and rates for depressive patients thought likely to benefit from antidepressants (according to a severity criterion) in primary care patients. These two rates are compared with assessments by 11 GPs of recognised depression, as well as with rates of drug prescribed.


RESULTS
The rate for depression thought likely to be treated with antidepressants estimated with the PHQ is broadly comparable with the rate for conspicuous depressive illness, and much lower than that predicted by the PHQ for depression. There was great variability between GPs in their ability to detect depression, and their preparedness to prescribe antidepressants. Antidepressants were only prescribed for 3.5% of the patients, compared to the 8.9% thought to need them. However, antidepressants, mostly SSRIs, are much more likely to be prescribed than tranquillisers.


CONCLUSIONS
The limitations of the study are that the PHQ is able to estimate 'coverage' but not 'focusing' (the proportion of those receiving antidepressants who needed them).


CONCLUSIONS
Although the rate for conspicuous depression is similar to that for depressions thought to be treated with antidepressants, the 'coverage' of antidepressants was only 39.3%. The variability between physicians confirm the need of good practice guidelines and training packages for the identification and management of depression. Large epidemiological studies are needed to overcome the current lack of clinically relevant data on the quality of antidepressant prescriptions in general practice.
Bellantuono
Cesario
C
The Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Ospedale Policlinico, 37134, Verona, Italy. bellant@galactica.it
Mazzi
Maria Angela
MA
Tansella
Michele
M
Rizzo
Raffaella
R
Goldberg
David
D
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents