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Tijdschrift voor Psychiatrie 35 (1993) 2

New research

Depression in the practice of GP's; consequences for training, research and management

W. van den Brink, J. Ormel

Recently, psychiatric epidemiologists and primary care physicians have been encountered in a active debate regarding the prevalence, recognition, diagnosis, and treatment of depression in primary care.

In a review of the (Dutch) literature, the authors conclude that depression is a very prevalent disorder in primary care (year prevalence: 55/1000), and that it is associated with considerable social disability and an increased of suicide (attempts). Depression and physical complaints often co-occur in a rather complex manner. As a consequence, 40-50% of the depressiomp is not recognized by the primary care physician, probably leading to some level of `under-treatment'. Moreover, only 15-20% of the recognized cases are being diagnosed as depression, probably leading to treatments that are less specific than might be possible. However, as of today there is little evidence for the effectiveness of specific interventions in primary care settings. Therefore, the authors conclude that large scale information and intervention programs are not expedient. Instead, our efforts should be focused om (1) controlled studies, regarding the effectiveness of specific interventions and training programs and (2) the training of medical students and primary care residents in recognition, diagnosis and treatment of depression.