Recognition of depression and appropriateness of antidepressant treatment in Italian primary care

Abstract.

Background:

A significant proportion of primary care patients are affected by a depressive disorder and about half of these patients are undetected and undertreated.

Methods:

Twenty-five primary care physicians (PCPs) were recruited in five Italian centres. All consecutive patients who attended the PCPs’ clinics in a 2-week period completed the Personal Health Questionnaire (PHQ), and those scoring more than nine on the PHQ were interviewed with the Hamilton Rating Scale for Depression—17 items (HDRS-17). The appropriateness of antidepressant drug treatment was assessed according to the decision to treat, the coverage, the type of drug and the dosage prescribed.

Results:

The adjusted prevalence for ICD-10 depression in 2093 patients was 18.7%, while the conspicuous morbidity was 10.7%. The ability of PCPs to detect a depression increased proportionally with HDRS scores. The coverage, i. e. the proportion of patients who would benefit from an antidepressant (AD) and who actually received such drugs, was 20.9%. The drugs most frequently prescribed were SSRI (36 %), followed by TCA (21%) and by other AD. Most SSRI were prescribed at therapeutic dosage, while two-thirds of TCA were at sub-therapeutic dosage. About 37% of patients started a non-pharmacological treatment. The severity of depression at the first consultation predicted the persistence of a depressive state in the longer term.

Conclusions:

The ability of Italian PCPs to detect depression is satisfactory when the patient’s depressive state is moderate or severe. The appropriateness of antidepressant drug treatment still needs to be improved.