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Research

Effective management of depression in primary care: a review of the literature

Bruce Arroll, Fiona Moir and Tony Kendrick
BJGP Open 2017; 1 (2): bjgpopen17X101025. DOI: https://doi.org/10.3399/bjgpopen17X101025
Bruce Arroll
1 Elaine Gurr Chair of General Practice and Primary Health Care, and Director of the Goodfellow Unit, Department of General Practice and Primary Care, University of Auckland, , New Zealand
MCCM (NZ), PhD, FAFPHM (RACP), RNZCGP, FNZCPHM
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  • For correspondence: bruce.arroll{at}auckland.ac.nz
Fiona Moir
2 Senior Lecturer, Department of General Practice and Primary Care, University of Auckland, , New Zealand
PhD, MRCGP
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Tony Kendrick
3 Professor of Primary Care, Primary Care and Population Sciences, University of Southampton, , UK
BSc, MD, FRCGP, FRCPsych (Hon)
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    Figure 1. Funnel plot of SSRI and TCA versus placebo from primary care antidepressant versus placebo review. 18

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    Table 1. Range of depression scores versus severity for PHQ-9 and HADS
    SeverityPHQ-9 (maximum 27) HADs (maximum 21)
    Minimal1–40–7
    Mild5–98–10
    Moderate10–140
    Moderate–severe15–19≥11
    Severe≥200
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    Box 1. PHQ-9 scores at diagnosis and proposed treatment actions 17
    PHQ-9 scoreDepression severityProposed treatment actions
    0–4None–minimalNone
    5–9MildWatchful waiting; repeat PHQ-9 at follow-up
    10–14ModeratePsychological treatment and follow-up/antidepressants
    15–19Moderate–severeAntidepressants and psychological treatment
    20–27SevereReferral to mental health
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    Table 2. Mismatch between PHQ-9 symptom questionnaire scores and psychiatric diagnoses.
    Severity on PHQ-9, N = 2642Depressed on DSM IV, N = 583 (% all patient)Not depressed on DSM IV, N = 2059 (% all patient)
    Mild 5–9156 (6)402 (15.2)
    Moderate 10–14102 (3.9)102 (3.9)
    Moderate-severe 15–1966 (2.5)24 (0.9)
    Severe 20–2737 (1.4)10 (0.4)
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July 2017
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Effective management of depression in primary care: a review of the literature
Bruce Arroll, Fiona Moir, Tony Kendrick
BJGP Open 2017; 1 (2): bjgpopen17X101025. DOI: 10.3399/bjgpopen17X101025

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Effective management of depression in primary care: a review of the literature
Bruce Arroll, Fiona Moir, Tony Kendrick
BJGP Open 2017; 1 (2): bjgpopen17X101025. DOI: 10.3399/bjgpopen17X101025
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  • Top
  • Article
    • What is depression: a biochemical disorder or a social construct or both?
    • Formal definitions of depression
    • Other ways of measuring depression severity to facilitate choice of treatment
    • Detecting bipolar disorder
    • Complex situations
    • Depression or anxiety: the emergence of transdiagnostic approaches
    • The NICE stepped-care model
    • Relapse prevention
    • Conclusion
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    • References
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Keywords

  • depression
  • review
  • primary care

More in this TOC Section

  • The role of reflexivity in exploring exclusion in GP training: a qualitative study of GP educators
  • Has the new Scottish GP contract improved GPs’ working lives in deprived areas? A secondary analysis of two cross-sectional national surveys of GPs’ views in 2018 and 2023
  • Challenges in reducing the 10-item CARE Measure to a two-item version: comparison of patients’ preferences with psychometric evaluation in a cross-sectional survey in Scotland
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