Communicative skills of general practitioners augment the effectiveness of guideline-based depression treatment.
BACKGROUND
Although good physician communication is associated with positive patient outcomes, it does not figure in current depression treatment guidelines. We examined the effect of depression treatment, communicative skills and their interaction on patient outcomes for depression in primary care.


METHODS
In a cohort of 348 patients with ICD-10 depression in primary care, patient outcomes were studied over 3- and 12-month follow-ups. The association of these outcomes with both depression-specific process of care variables and a nonspecific variable-communicative skillfulness of GP-was examined. Patient outcomes consisted of change from baseline in symptomatology, disability, activity limitation days, and duration of the depressive episode.


RESULTS
In accordance with treatment guidelines, some main effects of depression treatment were found, in particular on symptomatology, but these remained small (effect size<0.50). A moderate effect was found for treatment with a sedative, which proved to be related to worse patient outcomes at 12 months. An accurate GP diagnosis of depression and adequate antidepressant treatment were associated with better patient outcomes, but only when provided by GPs with good communicative skills. In contrast to the main effects, these interactions were seen on disability and activity limitation days, not on symptomatology.


CONCLUSIONS
The study is observational and does not permit firm conclusions about causal relationships. Communicative skillfulness of the GP was assessed by patient report only.


CONCLUSIONS
Neither depression-specific interventions nor good GP communication skills seem to be sufficient for optimal patient improvement. Only the combination of treatments according to guidelines and good communication skills results in an effective antidepressive treatment.
van Os
Titus W D P
TW
Department of Psychiatry and Graduate School of Behavioral and Cognitive Neuroscience's, University of Groningen, The Netherlands. T.W.D.P.van.Os@acggn.azg.nl
van den Brink
Rob H S
RH
Tiemens
Bea G
BG
Jenner
Jack A
JA
van der Meer
Klaas
K
Ormel
Johan
J
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003142:Communication; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D010817:Physician-Patient Relations; D010821:Physicians, Family; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000928:Antidepressive Agents