Gaps in depression care: why primary care physicians should hone their depression screening, diagnosis, and management skills.
OBJECTIVE
To highlight the potential role that occupational and environmental physicians can play in providing high quality depression care by describing: the profound impact that depression can have on development and persistence of unexplained medical symptoms such as pain; the impact of depression on social and occupational functioning; the adverse effect of comorbid depression in patients with chronic medical illness on self-care and medical outcomes; and the significant direct and indirect costs associated with depression.


METHODS
Literature review.


RESULTS
Despite evidence-based treatment guidelines, suboptimal depression care persists.


CONCLUSIONS
Building on the tenets of the chronic illness care model as well as the principles of public health, three approaches are required to address the gaps between knowledge and practice: 1) improve accuracy of diagnosis; 2) prevent chronic depression; and 3) prevent relapse and recurrence.
Seelig
Michelle D
MD
Department of Veterans Affairs, Puget Sound Healthcare System, HSR&D Center of Excellence, Seattle, WA 38121, USA. seelip@mac.com
Katon
Wayne
W
D002983:Clinical Competence; D003863:Depression / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D010819:Physician's Role; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D011361:Professional Competence; D016896:Treatment Outcome