Effectiveness of a multi-component programme for managing depression in primary care: a cluster randomized trial. The INDI project.

BACKGROUND: There are significant shortcomings in the management and clinical outcomes of depressed patients. The objective is to assess the effectiveness of a multi-component programme to improve the management of depression in primary care. METHODS: This is a cluster-randomized controlled trial, conducted between June 2007 and June 2010. Twenty primary care centres were allocated to intervention group or usual care group. The intervention consisted of a multi-component programme with clinical, educational and organizational procedures including primary care nurses working as case-managers. Outcomes were monitored by a blinded interviewer at 0, 3, 6 and 12 months. TRIAL REGISTRATION: ISRCTN16384353, at http://isrctn.org. RESULTS: In total, 338 adult patients with major depression (DSM-IV) were assessed at baseline. At 12 months, 302 patients were assessed, 172 in the intervention group and 130 in the control group. The severity of depression (mean Patient Health Questionnaire-9 score) was 1.76 points lower in the intervention group [7.15 vs. 8.78, 95% CI=-3.53 to 0.02, p=0.053]. The treatment response rate was 15.4% higher in the intervention group than in the controls [66.9% vs. 51.5%, odds ratio 1.9, 95% CI=1.2 to 3.1, p=0.011)], and the remission rate was 13.4% higher [48.8% vs. 35.4%, odds ratio 1.8, 95% CI=1.1 to 2.9, p=0.026)]. LIMITATIONS: Unblinded physicians diagnosed depression in their patients and decided whether to include them in the study, so we cannot discount a hidden selection bias. CONCLUSIONS: The programme for managing depression leads to better clinical outcomes in patients with major depression in primary care settings.

Actitudes y opiniones de los médicos de familia frente a la depresión: una aproximación con el Depression Attitudes Questionnaire (DAQ) / Attitudes and opinions of family doctors on depression: application of the Depression Attitudes Questionnaire (DAQ)

ObjetivoDescribir las actitudes de los médicos de Atención Primaria hacia la depresión.DiseñoEstudio transversal basado en la aplicación de un cuestionario estandarizado.Emplazamiento y participantes112 médicos de Atención Primaria de los 20 Centros de Salud de la Dirección de Atención Primaria Tarragona-Reus (Institut Català de la Salut).MedicionesSe usó una adaptación española del Depression Attitudes Questionnaire.ResultadosEl 88,4% está de acuerdo en que hay un aumento en la presencia de pacientes depresivos en los últimos años. Aproximadamente la mitad de los médicos opinan que la depresión en Atención Primaria a menudo se debe a adversidades de la vida, pero el 72,3% reconoce el carácter biológico en los casos de depresión severa. El 81,2% cree que los antidepresivos usados en Atención Primaria son eficaces y la mayoría valora la psicoterapia como una opción terapéutica útil. Existe acuerdo en el papel de la enfermería en la atención al paciente deprimido y se reconoce el papel de la derivación al psiquiatra cuando no se obtiene un resultado satisfactorio en Atención Primaria. El 64,3% de los médicos consideran que el manejo de los pacientes deprimidos es duro, aunque el 57,1% se sienten cómodos y solamente el 19,7% consideran que esta dedicación no es gratificante.ConclusionesSe halla, en general, una favorable predisposición hacia el manejo de la depresión en Atención Primaria donde pueden establecerse y fructificar iniciativas formativas y organizativas para mejorar los resultados de la depresión(AU)

AimTo describe the attitudes of General Practitioners (GPs) towards depression in Primary Health Care Centres.DesignCross-sectional study based on the application of a standard questionnaire.Setting and participantsA total of 112 GPs from all of the 20 Primary Health Care Centres in the Tarragona-Reus Primary Care Area (Catalan Health Institute).MeasurementsA Spanish adaptation of Depression Attitudes Questionnaire was used.ResultsA total of 88.4% of doctors agreed there was an increase in the number of depressive patients in recent years. Around half of the GPs thought that depression in Primary Health Care Centres are due to the adversities of life, but 72.3% considers that there is a biological root in severe depressions. A large majority (81.2%) of doctors believed that antidepressants used in Primary Care are efficient and the majority values psychotherapy as a useful therapeutic option. There is an agreement in the role of nursing staff when attending depressed patients. The role of psychiatric referral when a satisfactory result is not obtained in Primary Care is recognised. Although 64.3% of doctors consider that dealing with depressed patients is hard work, but 57.1% feel comfortable and only 19.7% think it is an unpleasant job.ConclusionsIn general, there is a favourable predisposition to deal with depression in Primary Care where training and organisational initiatives can be introduced to improve clinical outcomes of depression in Primary Care(AU)

[Attitudes and opinions of family doctors on depression: application of the Depression Attitudes Questionnaire (DAQ)]. / Actitudes y opiniones de los médicos de familia frente a la depresión: una aproximación con el Depression Attitudes Questionnaire (DAQ).

AIM: To describe the attitudes of General Practitioners (GPs) towards depression in Primary Health Care Centres. DESIGN: Cross-sectional study based on the application of a standard questionnaire. SETTING AND PARTICIPANTS: A total of 112 GPs from all of the 20 Primary Health Care Centres in the Tarragona-Reus Primary Care Area (Catalan Health Institute). MEASUREMENTS: A Spanish adaptation of Depression Attitudes Questionnaire was used. RESULTS: A total of 88.4% of doctors agreed there was an increase in the number of depressive patients in recent years. Around half of the GPs thought that depression in Primary Health Care Centres are due to the adversities of life, but 72.3% considers that there is a biological root in severe depressions. A large majority (81.2%) of doctors believed that antidepressants used in Primary Care are efficient and the majority values psychotherapy as a useful therapeutic option. There is an agreement in the role of nursing staff when attending depressed patients. The role of psychiatric referral when a satisfactory result is not obtained in Primary Care is recognised. Although 64.3% of doctors consider that dealing with depressed patients is hard work, but 57.1% feel comfortable and only 19.7% think it is an unpleasant job. CONCLUSIONS: In general, there is a favourable predisposition to deal with depression in Primary Care where training and organisational initiatives can be introduced to improve clinical outcomes of depression in Primary Care.