The care of patients with subthreshold depression in primary care: is it all that bad? A qualitative study on the views of general practitioners and patients.
BACKGROUND
Studies show that subthreshold depression is highly prevalent in primary care, has impact on the quality of life and causes immense health care costs. Although this points to the clinical relevance of subthreshold depression, contradictory results exist regarding the often self-remitting course of this state. However, first steps towards quality improvement in the care of subthreshold depressive patients are being undertaken. This makes it important to gather information from both a GPs' and a patients' point of view concerning the clinical relevance as well as the status quo of diagnosis and treatment in order to appraise the need for quality improvement research.


METHODS
We conducted qualitative, semi-structured interviews for the questioning of 20 GPs and 20 patients with subthreshold depression on aspects of clinical relevance and on the status quo of diagnosis and treatment. Interviews were transcribed and analyzed on a content analytical theoretical background using Atlas.ti software.


RESULTS
Most of the GPs found subthreshold depression to be clinically significant. Although some problems in diagnosis and treatment were mentioned, the GPs had sensible diagnostic and treatment strategies at hand which resulted from the long and trustful relationship with the patients and which corresponded to the patients' expectations. The patients rather expected their GP to listen to them than to take specific actions towards symptom relief and, in the main, were satisfied with the GPs' care.


CONCLUSIONS
The study shows that subthreshold depression is a clinically relevant issue for GPs but raises the possibility that quality improvement might not be as necessary as past studies showed. Further quantitative research using larger random samples is needed to determine the effectiveness of the strategies used by the GPs, patients' satisfaction with these strategies and the course of these patients' symptoms in primary care.
Backenstrass
Matthias
M
Centre for Psychosocial Medicine, Clinic of General Adult Psychiatry, University of Heidelberg, Vossstr, 4, D-69115 Heidelberg, Germany. matthias_backenstrass@med.uni-heidelberg.de
Joest
Katharina
K
Rosemann
Thomas
T
Szecsenyi
Joachim
J
D001291:Attitude of Health Personnel; D003863:Depression / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D011788:Quality of Life