title: Chronic physical comorbidity burden and the quality of depression treatment in primary care: a systematic review.
abstract: OBJECTIVE
  We examined whether the treatment and follow-up care for depression in routine primary care differs between adults with higher chronic physical comorbidity burden compared to adults with lower chronic physical comorbidity burden and explored factors leading to divergent results across studies.
  
  
  METHODS
  We conducted a systematic review of English and French articles using Medline, Embase, PsycINFO, CINAHL and Cochrane Controlled Trials Register from inception to July 2013. Reference list and reverse citation searches were also conducted. Search terms included depression, primary care, general practitioner, chronic disease and comorbidity. Study eligibility required inclusion of relevant quality indicators and data contrasting participants with higher and lower chronic physical comorbidity burden. Study selection and quality appraisal were carried out independently by two review authors. A narrative synthesis of results was performed.
  
  
  RESULTS
  Our search yielded 5817 unique citations and 46 studies met inclusion criteria. Studies provided data on quality of pharmacotherapy (n=28), psychotherapy (n=4), combined measures of treatment quality (n=14), and follow-up care (n=9). Across studies, evidence that higher chronic physical comorbidity burden was associated with lower depression treatment or follow-up care quality was reported in 13 studies whereas evidence for the opposite relationship was reported in 15 studies. Four studies reported mixed results and 14 studies observed no relationships between comorbidity burden and depression treatment or follow-up care quality.
  
  
  CONCLUSIONS
  Review findings suggest that chronic physical comorbidity does not consistently lead to lower quality of depression treatment or follow-up care in primary care.
authors: School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada.
authors: Matthew
authors: M
authors: Menear
authors: School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada.
authors: Isabelle
authors: I
authors: Doré
authors: CHUM Research Centre, Canada.
authors: Anne-Marie
authors: AM
authors: Cloutier
authors: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada.
authors: Laure
authors: L
authors: Perrier
authors: Department of Family Medicine and Emergency Medicine, Sherbrooke University, Canada.
authors: Pasquale
authors: P
authors: Roberge
authors: School of Public Health, University of Montreal, Canada; Faculty of Nursing, University of Montreal, Canada.
authors: Arnaud
authors: A
authors: Duhoux
authors: Department of Psychology, Université du Québec à Montréal, Canada.
authors: Janie
authors: J
authors: Houle
authors: School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada. Electronic address: louise.fournier@umontreal.ca.
authors: Louise
authors: L
authors: Fournier
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease / Q000523:psychology*; D003131:Combined Modality Therapy / Q000592:standards; D015897:Comorbidity; D017281:Cost of Illness; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011613:Psychotherapy / Q000592:standards
chemical_list: D000928:Antidepressive Agents
keywords: Chronic disease; Comorbidity; Depression; Primary care; Systematic review; Treatment