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Primary Care

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Helping patients recover from depression should be a high priority in primary care practices

Primary care patients with depression have worse mental health, are less able to function socially, and view their quality of life as worse than patients with most common chronic medical conditions such as arthritis or diabetes, finds a study supported by the Agency for Healthcare Research and Quality (HS08349). Yet diagnosis and treatment for depression in managed care primary care settings remain moderate at best. Primary care physicians (PCPs) should place more emphasis on helping patients recover from depression, recommend study authors Kenneth B. Wells, M.D., M.P.H., and Cathy D. Sherbourne, Ph.D., of RAND Corporation.

Drs. Wells and Sherbourne used various questionnaires to determine how 17,558 outpatients of 181 PCPs in 7 managed care organizations assessed their current health and quality of life, as well as their mental health and emotional and social role functioning. They then compared these assessments for depressed patients with those of patients who had chronic medical conditions ranging from back problems and arthritis to hypertension. Mental health-related quality of life (HRQOL) was poorer for those with depression, and physical functioning was poorer for those with a medical condition. Patients with both types of conditions valued their overall current state of health the lowest. On global mental health, emotional role functioning, and social functioning scales, depressed patients had significantly worse HRQOL than did patients who had a chronic medical condition.

Patients with each of several affective syndromes (lifetime bipolar disorder, 12-month double depression, major depression, or dysthymia) had significantly worse physical functioning and global mental health and valued the quality of their life lower than did patients without an affective syndrome. Patients with either 12-month double depression (major depression and dysthymia) or lifetime bipolar disorder had the poorest quality of life and were the least satisfied with their current health.

See "Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices," by Drs. Wells and Sherbourne, in the October 1999 Archives of General Psychiatry 56, pp. 897-904.

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