Management of major depression in the primary care setting

Background: Patients treated in community clinics, particularly those of mi nority status, may rely more heavily on primary care physicians (PCPs) for the diagnosis and management of depression. We wished to determine how PCPs in a community clinic setting initially manage patients newly diagnosed wi th major depression. Methods: 698 patients were screened for major depressi on by the Structural Clinical interview for DSM-III-R in a community-based primary care health center. Forty outpatients (29 Hispanic) were found to s uffer from major depression. A letter explaining positive findings was sent to the patients' PCPs. Medical record charts were reviewed 3 months later to determine the PCP's management following the diagnosis. Results: Of the 38 patients who remained in the study at 3 months, 20 (53%) received no int ervention from the PCP by the end of 3 months after diagnosis, and of these , 14 were Hispanic. Five (13%) were prescribed an antidepressant by the PCP . Nine (24%) were referred to mental health services for medication, psycho therapy or combination treatment. Four (11%) ere prescribed an antidepressa nt and then referred to mental health services. Differences between managem ent of Hispanic and non-Hispanic patients were not statistically significan t. Conclusions: Independent screening by psychiatrists in primary care sett ings may not be adequate enough to ensure appropriate management of depress ion by PCPs. Possible explanations may include time constraints during prim ary care visits, patient and/or physician reticence, and insufficient educa tion of PCPs about depression. Copyright (C) 2001 S. Karger AG, Basel.