Treatment outcome and physician-patient communication in primary care patients with chronic, recurrent depression.
OBJECTIVE
The authors' goal was to assess the adequacy of control, quality of life, and treatment experiences of patients with chronic, recurrent depression being treated by primary care physicians.


METHODS
The sample comprised 1,001 patients 18 years old or older who had chronic, recurring depression and were currently being treated with a single antidepressant prescribed by a primary care physician. These patients had responded positively to questions regarding the presence of clinical depression and prescription of a single antidepressant by a primary care physician during a telephone survey conducted in two stages separated by 18 to 24 months. The 1,001 patients participated in a structured, 20-minute, anonymous interview conducted by trained personnel.


RESULTS
Most patients had recurrent depression (median=5 episodes), and most had taken their current antidepressant for more than 1 year. The mean age at onset of depression was 33.8 years, and the mean age at time of diagnosis was 38.0 years, with treatment following a mean of 2 years later. Most patients were satisfied with the care they received from their primary care physician, but many also reported incomplete symptom resolution and substantial side effects from medications that were not discussed with or by their primary care physician. A majority of patients reported that treatment decisions were made in conjunction with their physician, a method that was preferred by three-quarters of the group. Although 752 patients reported that they had mild or moderate depression, 729 were satisfied with their life and 600 said they were in good or excellent health.


CONCLUSIONS
Despite being mostly satisfied with the care received from their primary care physician, patients with chronic, recurring depression had substantial levels of continuing dysfunction, distress, unrelieved symptoms, and medication side effects, which suggests several possible physician-centered, patient-centered, or system-centered barriers to treatment to full function and wellness.
Department of Family Medicine, L2003, Box 0239, Ann Arbor, MI 48109, USA. tschwenk@umich.edu.
Thomas L
TL
Schwenk
Dwight L
DL
Evans
Sally K
SK
Laden
Lydia
L
Lewis
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003142:Communication; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D006302:Health Services Research / Q000379:methods; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology / Q000592:standards; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome
D000928:Antidepressive Agents