12-Month naturalistic outcomes of depressive disorders in Hong Kong's primary care.
BACKGROUND
In Asia, the role of primary care physicians (PCPs) in mental health delivery is not clearly defined and what happens to patients following a depressive episode remains poorly understood.


OBJECTIVE
To examine the 12-month naturalistic outcomes of depression in primary care and the impact of PCP identification.


METHODS
A cohort study was conducted. A total of 10179 adults were consecutively recruited from the waiting rooms of 59 PCPs across Hong Kong to complete a survey which screened for depression. Blinded doctors provided data on their diagnosis and management; 539 screened-positive and 3819 screened-negative subjects consented to telephone follow-up at 3, 6 and 12 months. Study instruments included Patient Health Questionnaire-9, Centre for Epidemiologic Studies Depression Scale 20 and Short-Form Health Survey Version 2.0 (SF-12v2) and self-reported mental health and primary care service use.


RESULTS
12-month remission rate was 60.31%. PCP detection had no association with remission. Identified patients had poorer health-related quality of life (HRQOL) at baseline but a faster rate of recovery in SF-12v2 mental component scores. PCP detection was associated with greater mental health service use at 12, 26 and 52 weeks, while GP consultation rates were only increased at 12 weeks.


CONCLUSIONS
Over 1 year, ~60% of depressed patients experience symptom resolution, while 40% continue to suffer a chronic or remitting course of illness. Identification of depression by a PCP does not appear to affect remission of mood symptoms at 12 months, but is associated with a faster rate of recovery of HRQOL. PCP detection raises GP consultation rates temporarily however appears to enable more patients to access mental health services over 12 months.
Department of Family Medicine & Primary Care and Institute of Medical and Health Sciences Education, The University of Hong Kong, Hong Kong, Hong Kong SAR. chinwy@hku.hk.
Weng Yee
WY
Chin
Department of Family Medicine & Primary Care and.
Kit T Y
KT
Chan
Department of Family Medicine & Primary Care and.
Cindy L K
CL
Lam
Department of Family Medicine & Primary Care and.
Eric Y F
EY
Wan
Department of Family Medicine & Primary Care and.
Tai Pong
TP
Lam
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002983:Clinical Competence / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012075:Remission, Spontaneous; D055815:Young Adult
Chinese; Hong Kong; cohort study; depressive disorders; primary care