title: Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network.
abstract: BACKGROUND
  This study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong.
  
  
  METHODS
  A cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management.
  
  
  RESULTS
  10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor.
  
  
  CONCLUSIONS
  About one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.
authors: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China. chinwy@hku.hk.
authors: Weng Yee
authors: WY
authors: Chin
authors: Kit T Y
authors: KT
authors: Chan
authors: Cindy L K
authors: CL
authors: Lam
authors: Samuel Y S
authors: SY
authors: Wong
authors: Daniel Y T
authors: DY
authors: Fong
authors: Yvonne Y C
authors: YY
authors: Lo
authors: Tai Pong
authors: TP
authors: Lam
authors: Billy C F
authors: BC
authors: Chiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035843:Biomedical Research; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D055815:Young Adult