title: The influence of comorbid chronic physical conditions on depression recognition in primary care: a systematic review.
abstract: OBJECTIVE
  People with depression often suffer from comorbid chronic physical conditions and such conditions are widely believed to interfere with primary care providers' ability to recognize their depression. We aimed to examine the evidence related to the influence of chronic physical comorbidity burden on depression recognition in routine, community-based primary care settings.
  
  
  METHODS
  We conducted a systematic review of the literature on depression recognition in primary care that featured comparisons between patient groups with higher and lower burdens of chronic physical comorbidity. Medline, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials were searched from inception to July 2013. Reference list and reverse citation searches were also performed. A narrative synthesis was conducted given clinical and methodological heterogeneity between studies.
  
  
  RESULTS
  Our search identified 5817 unique citations, out of which we identified 13 studies reporting data on the relationship between chronic physical comorbidity burden and depression recognition in primary care. Four studies provided some evidence that higher chronic physical comorbidity burden negatively affected primary care providers' ability to recognize depression. In contrast, two studies reported higher rates of recognition in patients with higher comorbidity burden and seven studies reported no differences in recognition between comorbidity groups.
  
  
  CONCLUSIONS
  Chronic physical comorbidity burden does not consistently affect depression recognition negatively in primary care. Instead, recognition seems to vary depending on the specific conditions or combination of conditions examined. Methodological choices of authors, such as approaches to measuring recognition and chronic medical comorbidity, also likely explain some divergent results across studies.
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: D002908:Chronic Disease / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D011320:Primary Health Care / Q000592:standards
keywords: Chronic disease; Comorbidity; Depression; Primary care; Recognition; Systematic review