title: Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study.
abstract: BACKGROUND
  A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital.
  
  
  METHODS
  Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ). Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records.
  
  
  RESULTS
  Among 312 patients, 27 (8.7%) and 52 (16.7%) were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8%) were recognized by physicians as having a mental disorder, but only three (11.1%) were diagnosed as having a mood disorder.Only two patients with major depressive disorder (7.4%) had been prescribed antidepressants. Even among those (n = 15) whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7%) were prescribed an antidepressant.
  
  
  CONCLUSIONS
  Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring patients to mental health specialists.
authors.affiliation: Department of Psychogeriatrics, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira City, Tokyo, Japan.
authors.forename: Tsuyuka
authors.initials: T
authors.lastname: Ohtsuki
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Inagaki
authors.forename: Yuetsu
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Saitoh
authors.forename: Mie
authors.initials: M
authors.lastname: Kurosawa
authors.forename: Kumiko
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy*; D005194:Family Practice / Q000379:methods / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006306:Health Surveys; D006780:Hospitals, Rural / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards*; D007564:Japan / Q000208:ethnology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019964:Mood Disorders / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy; D010044:Outpatient Clinics, Hospital / Q000592:standards; D015995:Prevalence; D011795:Surveys and Questionnaires