Short-term follow-up of patients diagnosed by their GP with mild depression or first-time moderate depression. Results of a 1-year nationwide surveillance study
Background. Despite its public health significance, data about depression in general practice are often unavailable or incomplete. Objective. To study half-year follow-up data on patients diagnosed by their GP with a new episode of mild or a first episode of moderate depression, specifically: (i) treatment continuation, (ii) remission and, in ongoing episodes, suicidal behaviour and inability to work and (iii) the match between treatments initiated and delivered as well as the determinants of
... e determinants of actual delivery of non-pharmacological support initiated by the GP for patients with ongoing depression. Methods. General practice-based data were collected on all patients aged >18 years who were diagnosed by their GP with a new episode of depression in Belgian sentinel general practices during 2008. Results. Follow-up data were available for 900 of 1048 patients. Complete treatment dropout was found in 9%, treatment discontinuation in 40% and a GP visit <8 weeks preceding the follow-up in 51%. Of the latter 457 patients, 60% were still depressed. Among these, one suicide attempt was reported and 24% were unable to work for >1 month. While 91% of the patients who received psychoactive agents at diagnosis had actually taken them, and 62% of the referred patients actually received treatment from another caregiver, non-pharmacological support by the GP was delivered in only 43% of patients for whom it was initiated. Conclusions. Half a year after diagnosis, half of patients continue to visit their GP and 60% of those patients remain depressed. The delivery of non-pharmacological GP support takes place for less than half of the patients for whom that intervention is initiated. Our follow-up findings reinforce the policy recommendations made by stakeholders, i.e. the introduction and reimbursement of a mental health consultation in family practice and integration of primary care psychologists. Quality improvement interventions may be a strategy to overcome premature discontinuation of non-pharmacological support by GPs.