Effects of consulting psychiatrist in primary care - 1-year follow-up of diagnosing and treating anxiety and depression

Objective - Epidemiological screening of anxiety and depressive disorders i n primary care and evaluation of how these patients are identified and trea ted. Follow-up after 1 year of psychiatric consultation/liaison (C/L) and e ducational activities. Subjects and design-In the baseline study 374 unselected and consecutive pa tients, and in the follow-up study 254 patients (response rate 94.5% and 90 .3%, respectively) answered the screening instrument HAD scale (Hospital An xiety and Depression scale). The HAD results were compared to clinical diag nosis and treatment according to the medical records. Differences after 1 y ear were analysed. Results - At follow-up the prevalence of anxiety had increased from 11.8% t o 16.5% (p < 0.05), and of depression from 3.7% to 4.7% (NS) according to H AD. Also, at the follow-up more cases of anxiety disorders were clinically diagnosed - 13% vs 8% - as well as an increased number of cases of depressi ve disorders - 7.9% vs 4.0%. The agreement between HAD diagnosis and clinic al judgement had increased significantly (p < 0.001) for anxiety disorders from 37% to 70%, and for depression from 20% to 45%. Treatment prevalence h ad also improved (p < 0.001) at the follow-up for anxiety disorders from 33 % to 55% and for depression from 47% to 80%. In total, 4.0% of the baseline and 11.4% of the follow-up population were treated for anxiety and/or depr ession. Conclusions - Anxiety and depressive disorders are prevalent in primary car e. However, only a minority of these patients are identified and treated. P sychiatric consultant support seems to be effective in improving GP's diagn ostic and therapeutic skills thus enabling these widespread disorders to be identified at an early stage and properly treated.