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Who is identified when screening for depression is undertaken in general practice? Baseline findings from the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) longitudinal study

Jane M Gunn, Gail P Gilchrist, Patty Chondros, Melina Ramp, Kelsey L Hegarty, Grant A Blashki, Dimity C Pond, Mike Kyrios and Helen E Herrman
Med J Aust 2008; 188 (12): 119.

Summary

Objectives: To report the baseline characteristics of the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) study cohort and discuss the implications for depression care in general practice.

Design: A prospective longitudinal study beginning in January 2005.

Participants and setting: Adult patients with depressive symptoms identified via screening with the Center for Epidemiologic Studies Depression Scale (CES-D ≥ 16) in 30 randomly selected Victorian general practices.

Main outcome measure: Depression status on the Patient Health Questionnaire (PHQ).

Results: 789 patients form the cohort (71% women). At baseline, 47% were married, 21% lived alone, 36% received a pension or benefit, 15% were unable to work, 23% reported hazardous drinking, 32% were smokers, 39% used antidepressants and 19% used sedatives. 27% satisfied criteria for current major depressive syndrome (MDS) on the PHQ, while 52% had “persistent” depressive symptoms, and 22% had “transient” depressive symptoms, lasting at most a few weeks. Of those satisfying criteria for MDS, 49% were also classified with an anxiety syndrome, 40% reported childhood sexual abuse, 57% reported childhood physical abuse, 42% had at some time been afraid of their partner, and 72% reported a chronic physical condition; 84% were receiving mental health care (either taking antidepressants or seeing a health practitioner specifically for mental health care) compared with 66% of those with persistent depressive symptoms and 57% with transient depressive symptoms.

Conclusion: This method of screening for depressive symptoms in general practice identifies a group of patients with substantial multiple comorbidities — psychiatric, physical and social problems coexist with depressive symptoms, raising challenges for the management of depression in general practice.

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  • Jane M Gunn1
  • Gail P Gilchrist2
  • Patty Chondros1
  • Melina Ramp1
  • Kelsey L Hegarty1
  • Grant A Blashki1
  • Dimity C Pond3
  • Mike Kyrios4
  • Helen E Herrman5

  • 1 Primary Care Research Unit, Department of General Practice, University of Melbourne, Melbourne, VIC.
  • 2 Addiction and Substance-Related Disorder Research Group, Municipal Institute of Medical Research, Barcelona, Spain.
  • 3 Discipline of General Practice, University of Newcastle, Newcastle, NSW.
  • 4 Swin-PsyCHE Research Unit, Department of Psychology, Swinburne University of Technology, Melbourne, VIC.
  • 5 ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC.

Correspondence: j.gunn@unimelb.edu.au

Acknowledgements: 

The diamond study was funded by the National Health and Medical Research Council (ID 299869 & 454463) and the Victorian Centre for Excellence in Depression and Related Disorders, an initiative between beyondblue and the Victorian Government. Neither funding body had a role in study design; the collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit this manuscript for publication. We acknowledge the 30 dedicated GPs, their patients and practice staff for making this research possible. We thank the diamond project team, including the associate investigators and researchers involved in the study: Ms Darshini Ayton, Ms Vanessa Madden, Dr David Pierce, Ms Maria Potiriadis, Dr Lena Sanci, Dr Jane Sims, Ms Donna Southern and the casual research staff.

Competing interests:

None identified.

  • 1. Mathers CD, Vos ET, Stevenson CE, Begg SJ. The Australian Burden of Disease Study: measuring the loss of health from diseases, injuries and risk factors. Med J Aust 2000; 172: 592-596. <MJA full text>
  • 2. Parslow RA, Jorm AF. Who uses mental health services in Australia? An analysis of data from the National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2000; 34: 997-1008.
  • 3. Gunn J. Towards a practical solution for depression in general practice. N Z Fam Physician 2006; 33: 239-242.
  • 4. Council of Australian Governments. Communique — Council of Australian Governments’ Meeting 10 Feb 2006. http://www.coag.gov.au/meetings/100206/ (accessed Feb 2007).
  • 5. Dowrick C. Does testing for depression influence diagnosis or management by general practitioners? Fam Pract 1995; 12: 461-465.
  • 6. Gilbody S, Sheldon T, Wessely S. Should we screen for depression? BMJ 2006; 332: 1027-1030.
  • 7. Pignone MP, Gaynes BN, Rushton JL, et al. Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002; 136: 765-776.
  • 8. Hickie IB, Davenport TA, Naismith SL, Scott EM. Conclusions about the assessment and management of common mental disorders in Australian general practice. SPHERE National Secretariat. Med J Aust 2001; 175 (2 Suppl): S52-S55.
  • 9. Gunn J, Diggens J, Hegarty K, Blashki G. A systematic review of complex system interventions designed to increase recovery from depression in primary care. BMC Health Serv Res 2006; 6: 88.
  • 10. Gilchrist G, Gunn J. Observational studies of depression in primary care: what do we know? BMC Fam Pract 2007; 8: 28.
  • 11. Parker G, Abeshouse B, Morey E, et al. Depression in general practice. Med J Aust 1984; 141: 154-158.
  • 12. Herrman H, Patrick DL, Diehr P, et al. Longitudinal investigation of depression outcomes in primary care in six countries: the LIDO study. Functional status, health service use and treatment of people with depressive symptoms. Psychol Med 2002; 32: 889-902.
  • 13. Simon GE. Long-term prognosis of depression in primary care. Bull World Health Organ 2000; 78: 439-445.
  • 14. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1977; 1: 385-401.
  • 15. World Health Organization. Composite International Diagnostic Interview (CIDI-Auto), version 2.1. Geneva: WHO, 1997.
  • 16. Breslau N, Kessler RC, Chilcoat HD, et al. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998; 55: 626-632.
  • 17. Coffey C, Carlin JB, Degenhardt L, et al. Cannabis dependence in young adults: an Australian population study. Addiction 2002; 97: 187-194.
  • 18. Patton GC, Coffey C, Carlin JB, et al. Prematurity at birth and adolescent depressive disorder. Br J Psychiatry 2004; 184: 446-447.
  • 19. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282: 1737-1744.
  • 20. Department of Primary Industries and Energy, and Department of Human Services and Health. Rural, remote and metropolitan areas classification 1991 census edition. Canberra: AGPS, 1994.
  • 21. Hawthorne G, Herrman H, Murphy B. Interpreting the WHOQOL-Bref: preliminary population norms and effect sizes. Soc Indic Res 2006; 77: 37-59.
  • 22. Barnett AG, van der Pols JC, Dobson AJ. Regression to the mean: what is it and how to deal with it. Int J Epidemiol 2005; 34: 215-220.
  • 23. Thompson C, Ostler K, Peveler RC, et al. Dimensional perspective on the recognition of depressive symptoms in primary care: the Hampshire Depression Project 3. Br J Psychiatry 2001; 179: 317-323.
  • 24. Pirotta M, Gunn J, Harrison D. Accurate sampling in general practice waiting room surveys: methodological issues. Aust N Z J Public Health 2002; 26: 152-155.
  • 25. Nease DE Jr, Aikens JE. DSM depression and anxiety criteria and severity of symptoms in primary care: cross sectional study. BMJ 2003; 327: 1030-1031.
  • 26. Widiger TA, Samuel DB. Diagnostic categories or dimensions? A question for the Diagnostic and Statistical Manual of Mental Disorders — fifth edition. J Abnorm Psychol 2005; 114: 494-504.

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