Identificador: TDX:614
Autores: Aragonés Benaiges, Enric
Resumen:
INTRODUCTION<br/>Depressive disorders are a public health problem of the first order, both for their high prevalence and repercussion. Primary care is the main area in which these disorders can first be tackled and it is, in fact, where most patients with depression are dealt with. <br/>AIMS <br/>· To Determine the prevalence of depressive disorders (major depression and dysthymia) in attended patients.<br/>· To analyse the phenomenon of somatization of depression.<br/>· To analyse the role of general practitioners in the diagnosis and treatment of depression.<br/>METHOD<br/>The study was carried out in ten primary health care surgeries in Tarragona. A two phase study was designed. The first phase used Zung's Self-Rating Depression Scale to screen 906 consecutive patients who visited their general practitioner for a variety of health problems. The results of the screening led to a stratified subsample being selected, which was assessed in the second phase. This subsample consisted of all the 209 patients with a positive result and 97 patients with a negative result (1/7 random).<br/>The second phase consisted of a psychiatryc interview, plus a battery of questionnaires, which included motives for consultation and current symptoms, medical comorbidity, the medication taken, use of health services, functional and vital repercussions of depression and detection of depression by the patient's general practitioner.<br/>RESULTS<br/>Prevalence<br/>The prevalence of major depression was 14.3% (95 % CI: 11.2-17.4) and of dysthymia it was 4.8% (95 % CI: 2.8-6.8). The female sex, panic disorder, generalised anxiety disorder, gastroduodenal ulcer/gastritis, frequency of primary care visits and clinical presentation with psychological symptoms were independently associated with the presence of major depression. Generalised anxiety disorder, manifestation of psychological symptoms and presence of chronic organic diseases were independently associated with dysthymia<br/>Somatization<br/>45.5% of the cases of depressive disorders were classified as psychological presentation, 35.6% as somatization and 19.1% as a comorbid organic disorder with depression. Comparing depressed patients who manifested psychological symptoms with the somatizers, we found that the latter had a lower educational level and that depression was less severe and had fewer repercussions. Levels of detection, antidepressive treatment and specialized psychiatric care were lower in the somatizers.<br/>Detection<br/>The sensitivity of the general practitioner's clinical judgement about the presence of depression was 68.3% (IC 95%: 56.5-80.0) and the specificity was 73.5% (IC 95%: 66.1-81.0).<br/>Non-diagnostic of depression in depressed patients was associated with the lower educational level, lower severity and lower repercussion of the depression, and the exclusive manifestation of somatic symptoms.<br/>The classification of patients with no-depression as depressed (false positive) was associated with previous history of depression, to diagnosis from other subsyndromic depressive disorders, to the expression of psychological symptoms and to a worse self-perception of health.<br/>Treatment<br/>The proportion of depressed patients undergoing antidepressive treatment was 34%. The main variables associated with antidepressant treatment were severity and functional repercussions of the depression, frequency of primary care visits and psychological presentation.<br/>CONCLUSIONS<br/>Depression is frequent among the patients in primary care. <br/>Depression often presents in somatised form and this hinders detection and treatment.<br/>A significant proportion of depressed patients are not detected, but these often present mild forms of depression in which the benefits of detection are doubtful. Most depressed patients, in any state of severity, do not receive appropriate treatment.
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