title: Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation.
abstract: BACKGROUND
  Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.
  
  
  OBJECTIVE
  To compare general practice consultations and early outcomes for patients with depression  living in areas of high or low socioeconomic deprivation.
  
  
  METHODS
  Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at  1 month.
  
  
  METHODS
  Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.
  
  
  RESULTS
  PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression)  were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly  lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in  PHQ-9 score in both affluent and deprived areas.
  
  
  CONCLUSIONS
  In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve  in deprived areas because of the inverse care law and the burden of multimorbidity.
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
authors.forename: Bhautesh
authors.initials: B
authors.lastname: Jani
authors.forename: Annemieke P
authors.initials: AP
authors.lastname: Bikker
authors.forename: Maria
authors.initials: M
authors.lastname: Higgins
authors.forename: Bridie
authors.initials: B
authors.lastname: Fitzpatrick
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Graham C M
authors.initials: GC
authors.lastname: Watt
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005194:Family Practice / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D015995:Prevalence; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors; D016896:Treatment Outcome