We suggest that clinicians consider models of shared decision-making (SDM) for their potential ability to improve the treatment of major depression in the primary care setting and overcome limitations of collaborative care and other interventions. We explore the characteristics and techniques of patient-clinician SDM, with particular emphasis on this model's ...

We examined the feasibility and effectiveness of using culturally sensitive collaborative treatment (CSCT) to improve recognition, engagement, and treatment of depressed Chinese Americans in primary care. Chinese American patients in a primary care setting (n = 4228) were screened for depression. The primary study outcome was treatment engagement rate, and ...

Low- and middle-income countries lack information on contextualised mental health interventions to aid resource allocation decisions regarding healthcare. To undertake a cost-effectiveness analysis of treatments for depression contextualised to Chile. Using data from studies in Chile, we developed a computer-based Markov cohort model of depression among Chilean women to evaluate ...

Dialysis management is changing over time due to the changing dialysis population, with many overlapping issues between gerontological and nephrological care. The conditions that are focused on in this review are frailty, cognitive impairment, depression and changes in body composition. These factors should be considered when managing older patients on ...

This study was designed to determine whether a physician-delivered bibliotherapy prescription would compare favorably with the prevailing usual care treatment for depression in primary care (that often involves medication) and potentially offer an alternative. Six family physicians were trained to write and deliver prescriptions for cognitive-behavioral bibliotherapy. Thirty-eight patients were ...

The Chronic Care Model provides evidence-based recommendations to improve the care for patients with chronic conditions. The Patient Assessment of Chronic Illness Care questionnaire (PACIC) is an instrument to evaluate the patient's perspective on receipt of care delivered in the five domains patient activation, delivery system, goal setting, problem solving, ...

This study of Australian and Dutch people with anxiety or depressive disorder aims to examine people's perceived needs and barriers to care, and to identify possible similarities and differences. Data from the Australian National Survey of Mental Health and Well-Being and the Netherlands Study of Depression and Anxiety were combined ...

CONTEXT: Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings. OBJECTIVE: To examine the cost-effectiveness of a rural telemedicine-based collaborative care depression intervention. DESIGN: Randomized controlled trial of intervention vs usual care. SETTING: Seven small (serving 1000 ...

To report the one-year follow-up results of computerized cognitive behavioural therapy (CCBT), offered online without professional support, for depression compared with usual GP care and a combination of both treatments. To explore potential relapse prevention effects of CCBT. 303 depressed patients were randomly allocated to (a) unsupported online CCBT (b) ...

Screening for a major depressive episode (MDE) in high-risk groups of patients within the primary care setting has been suggested by several Central Health Organizations. The objective of this study was to investigate whether patients rated as "psychiatric cases" by their general practitioner (GP) were likely to suffer from MDE ...

OBJECTIVE: There is widespread concern about access to good quality health care for ethnic minority groups. This study investigates differences between ethnic groups regarding prevalence of anxiety and depression, and adherence to treatment guidelines by family practitioners in urban areas in the Netherlands. METHOD: Data from electronic medical records, collected ...

OBJECTIVE: This study aimed to assess the frequency of generalized anxiety disorder (GAD) among primary care patients in China. We also determined the rate of comorbid major depression (MD) in patients with GAD and explored the differences in sociodemographic and health-related characteristics between patients with and without GAD. METHOD: We ...

Comorbid depression and anxiety in late life present challenges for geriatric mental health care providers. These challenges include identifying the often complex diagnostic presentations both clinically and in a research context. This potent comorbidity can be conceived as double jeopardy in older adults, further diminishing their quality of life. Geriatric ...

To describe the direct and indirect costs for people with anxiety and depressive disorders where guidelines are adhered to and patients' perceived needs are fully met. Data were derived from the Netherlands Study of Depression and Anxiety. At baseline, adult patients were interviewed and they completed questionnaires to measure DSM-IV ...

To identify attitudinal and interpersonal barriers to depression care-seeking and disclosure in primary care and in so doing, evaluate the primary care paradigm for depression care in the United States. Fifteen qualitative focus group interviews in three cities. Study participants were English-speaking men and women aged 25-64 with first-hand knowledge ...

Stepped-care approaches may offer a solution to delivering accessible, effective and efficient services for individuals with depression. In stepped care, all patients commence with a low-intensity, low-cost treatment. Treatment results are monitored systematically, and patients move to a higher-intensity treatment only if necessary. We deliver a stepped-care model targeting patients ...

INTRODUCTION: Recently there has been pressure on Secondary Psychiatric services to discharge patients back into Primary care. This project is to show what depression treatments are used by Bedford East Community Mental Health Team (BECMHT) and therefore identify whether some of these patients could be appropriately managed in Primary care. ...

The paper by Fischer et al. focuses attention on the striking prevalence of depressive symptoms in non-dialyzed chronic kidney disease patients. The presence of depressive symptoms correlated with various health-related quality of life measures and economic status. These findings suggest that our view of providing care needs to broaden to ...

OBJECTIVE: Data from the 2006 National Ambulatory Medical Care Survey were examined for differences in the diagnosis and treatment of depressive and anxiety disorders in rural and nonrural primary care settings. METHODS: A sample of 11,658 patient visits to primary care providers was examined. ICD-9-CM codes were used to identify ...

BACKGROUND: Long-term treatment with antidepressants is considered effective in preventing recurrence of major depressive disorder (MDD). It is unclear whether this is true for primary care. OBJECTIVES: We investigated whether current guideline recommendations for long-term treatment with antidepressants in primary care are supported by evidence from primary care. METHODS: Data ...

OBJECTIVE: Translating Initiatives in Depression into Effective Solution (TIDES) aimed to translate research-based collaborative care for depression into an approach for the Veterans Health Administration (VA). SITES: Three multistate administrative regions and seven of their medium-sized primary care practices. INTERVENTION: Researchers assisted regional leaders in adapting research-based depression care models ...

Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder that is often undetected among primary care patients. The Department of Veterans Affairs has implemented the Primary Care-PTSD Screen (PC-PTSD) to screen for PTSD; however, minimal research has examined its utility. This study was designed to assess the diagnostic accuracy of ...

To describe the history and evolution of the collaborative depression care model and new research aimed at enhancing dissemination. Four keynote speakers from the 2009 NIMH Annual Mental Health Services Meeting collaborated in this article in order to describe the history and evolution of collaborative depression care, adaptation of collaborative ...

The objective of this study was to identify conditions that influence primary care clinicians' referral decisions related to depression care. Forty primary care clinicians (15 general internists, 10 nurse practitioners, and 15 family practice physicians) were included in this study. The clinicians participated in semistructured interviews and completed two quantitative ...

PURPOSE: Clinical care for depression in primary care negotiates a path between contrasting views of depression as a universal natural phenomenon and as a socially constructed category. This study explores the complexities of this work through a study of how family physicians experience working with different ethnic minority communities in ...

Evidence-based psychotherapies to treat depression are available, yet it remains unknown the extent to which these practices are used in routine care for depression. Using survey and administrative data, we sought to describe usual care psychotherapy for depression for adult patients receiving care through a large, managed behavioral health care ...

The World Health Organization and the World Organization of Family Doctors have called for 'doable' and 'limited' tasks to integrate mental health into primary care. Little information is provided about tasks GPs can undertake outside of guidelines that suggest to prescribe medication and refer to specialists. The reorder study aimed ...

Major depressive disorder (MDD) is a serious and prevalent mental health issue. As the majority of MDD cases are identified and treated by one's primary care physician, it is imperative that care providers utilize accurate and efficient methods for diagnosing MDD in primary care settings. The present study is the ...

Primary care physicians often perceive patients as unlikely to decrease their substance use and suggest this reluctance to change diminishes their willingness to screen and intervene. The literature on readiness to change has primarily focused on adults, and the available studies on adolescents have largely included hospitalized and/or incarcerated youths ...

There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders. To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care. An economic ...

Cognitive impairment occurs often in patients with chronic heart failure (CHF) and may contribute to sub-optimal self-care. This study aimed to test the impact of cognitive impairment on self-care. In 93 consecutive patients hospitalized with CHF, self-care (Self-Care of Heart Failure Index) was assessed. Multiple regression analysis was used to ...

Diabetes and coronary heart disease (CHD) are two of the most prevalent medical illnesses in the US population and comorbid depression occurs in up to 20% of these patients. Guidelines for management of diabetes and CHD overlap for healthy lifestyle and disease-control recommendations. However, the majority of patients with these ...

The prevalence of depression among older people receiving care is high, yet the rate of treatment of this disorder is low. One way to improve the pathway to care is to train care staff to recognize the symptoms of depression and raise their confidence in responding to them. In this ...

OBJECTIVE: To assess the effectiveness of consultation-liaison services, involving mental health professionals working to advise and support primary care professionals in the management of depression. METHODS: Studies of consultation-liaison for depression in primary care were identified from a systematic search of electronic databases, augmented by identification of papers from reference ...

PURPOSE OF REVIEW: The authors seek solutions to better meet the healthcare needs of depressed patients in primary care by improving the recognition of depression, other mood disorders and of a risk for suicide. RECENT FINDINGS: For 25 years academic psychiatry and primary care have known that only 10-50% of ...

OBJECTIVES: This study focused on patients in the general population whose anxiety or depressive disorder is untreated. It explored reasons for not receiving treatment and compared four groups of patients-three that did not receive treatment for different reasons (no problem perceived, no perceived need for care, and unmet need for ...

Books: Depression: Cognitive Behaviour Therapy with Children and Young People Pocket Guide to Clinical Examination (4th edn) Enhancing patient care: a practical guide to improving quality and safety in hospitals.

BACKGROUND: Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression ...

AIM: This paper is a report of a study conducted to identify and gain consensus on appropriate benchmarks for effective primary care-based nursing services for adults with depression. BACKGROUND: Worldwide evidence suggests that between 5% and 16% of the population have a diagnosis of depression. Most of their care and ...

This study examined whether a collaborative care model for depression would improve clinical and functional outcomes for depressed patients with chronic general medical conditions in primary care practices in Puerto Rico. A total of 179 primary care patients with major depression and chronic general medical conditions were randomly assigned to ...

Since Medicare first implemented the home care Outcome and Assessment Information Set (OASIS) in 1999, we have learned a great deal about depression among the homebound elderly. First, we know that major depression is a highly prevalent illness in home care. With depression rates at almost 15%, home care-along with ...

Depression is often diagnosed and treated in primary care settings. Organizational and systems interventions that restructure primary care practices and train staff have been shown to be cost-effective strategies for treating depression. Funders are increasingly calling for a cost-benefit assessment of such programs. In this study, the authors review existing ...

Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. This paper investigates whether two proposed stakeholders (health plans and employer purchasers) economically benefit from depression care management (reduced outpatient utilization ...

To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Seven hundred and twenty-one patients with a current anxiety or depressive disorder, recruited from 67 general practitioners ...

BACKGROUND: Psychological changes in terminally ill patients with liver disease are underestimated. Therefore, a psychological care unit was introduced in the liver transplantation unit in a transplantation hospital in Spain. OBJECTIVES: To describe the establishment of the psychological care unit in a liver transplantation unit and to review its operation, ...

A large gap exists between the number of people needing treatment and the number of people receiving treatment for depression in the Middle East. Barriers to mental health care in the region have included the lack of education for primary health care providers about mental illnesses, the scarcity of trained ...

This study evaluated the association between depression and hospitalization among geriatric home care patients. A sample of 477 patients newly admitted to home care over two years was assessed for depression. Bivariate and logistic regression analyses examined the likelihood of hospitalization during a 60-day home care episode. The hospitalization rate ...

Identifying the determinants of health-related quality of life (HRQOL) in patients with systolic heart failure (CHF) is rare in primary care; studies often lack a defined sample, a comprehensive set of variables and clear HRQOL outcomes. Our aim was to explore the impactof such a set of variables on generic ...

Depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked ...

The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence, glycemic control, and depression outcomes. Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care ...