1. Journal Club 30/09/05 V Dory GP treatment decisions for patients with depression: an observational study Kendrick T, King F, Albertella L, Smith P Br J Gen Pract 2005;55:280-6

2. Journal Club 30/09/05 V Dory Background  England : Increase in anti-depressant prescriptions- may be inappropriate  Many patients (2/3) with major depression are not receiving recommended treatment  This may be linked to GPs’ beliefs and patients’ beliefs

3. Journal Club 30/09/05 V Dory Research question : Understanding GP behaviour  What influences GP treatment decisions for depression: Severity of depression Patient demographic factors Adverse life events Past history Patient attitudes towards antidepressants (as seen by GPs/ as reported by patients)

4. Journal Club 30/09/05 V Dory Methods  Observational study  Patients: –HADS (HAD-D  severity) –Socio-demographic factors –Perceived financial difficulties –Brief schedule of threatening life events –Health status –Attitudes to antidepressants

5. Journal Club 30/09/05 V Dory  GPs: Is patient depressed : 0-4 If >= 2: Action taken Adverse life event or difficulties Patient’s attitude towards antidepressants Previous mental health problems Chronic physical health pbs Previous antidepressant treatment How well do you know patient Acknowledgement of diagnosis of depression

6. Journal Club 30/09/05 V Dory  Notes checked after 2 months for subsequent diagnosis of / treatment for depression

7. Journal Club 30/09/05 V Dory Methods: Recruitment  Recruitment of GP practices Phase I: 2 practices  9 GPs (of 9) Phase II: 6 practices (5 of 7 newly approached + 1 from phase I)  11 GPs (of 18) No information on selection process

8. Journal Club 30/09/05 V Dory Methods: recruitment  Patients Inclusion criteria:  >18 years old  Able to complete screening questionnaire Exclusion criteria:  Currently taking AD/psychiatric treatment  Terminal illness

9. Journal Club 30/09/05 V Dory  Consent Ph I : directly approached by researcher Ph II: approached by receptionist then researcher Consent slip given to GP before consultation

10. Journal Club 30/09/05 V Dory  Patients  437 + 257 patients = 694 patients  59%- 43% of appts  100 depressed  67 HAD-D 8-10  33 HAD-D >10

11. Journal Club 30/09/05 V Dory Results  Missing data  GPs completed questionnaires for 97-95% of patients enrolled  Patients all filled in HAD on the spot but sent other questionnaires by post in 73%-72% of cases (no difference in HAD-D score)

12. Journal Club 30/09/05 V Dory Results: diagnosis of depression  GPs are not very accurate: Ph IHAD + HAD - total GP +194261 GP -38326364 total57368425 Prév 13,4% Se 33% Sp 89% PPV 31% NPV 89% LR+ 3 LR- 0.75

13. Journal Club 30/09/05 V Dory Results: treatment decisions  Acknowledgement: 49%/35%  AD: 8%/22%  Follow-up/referral: 16%/7%

14. Journal Club 30/09/05 V Dory Results: association between AD offers and GP perceptions  Severity of depression Moderate>mild P = 0.019/0.001  Attitude of patient twds AD P= 0.045/0.004  Absence of adverse life events or difficulties P=0.03/0.847

15. Journal Club 30/09/05 V Dory Results: GP perceptions of patient’s attitudes  GP ‘pos attitude’ // patient ‘addictiveness’  GP ‘neg attitude’ # patient ‘effectiveness’

16. Journal Club 30/09/05 V Dory Results : changes between ph I and II  More offers of AD  No link between offer of AD and adverse life events BUT: Different population Insufficient numbers of GPs

17. Journal Club 30/09/05 V Dory Discussion : Main findings  Poor diagnostic accuracy  Management : –Lack of acknowledgement with patients –AD offers linked to severity and perceived patient attitude to AD

18. Journal Club 30/09/05 V Dory Limitations  Selection of practices???  Relatively small sample size re R/ decisions (101)  2 phases : different practices so no comparison feasable