News & Commentary

Anti-Depression Tool A Disappointment


A recent study by Spanish researchers posited: With the right diagnostic approach, primary care physicians (PCPs) should be able to get a bead on which of their patients might be most susceptible to major depression, and thereby intercept the problem before it begins.

Unfortunately, the results were less than convincing, according to the study published in the Annals of Internal Medicine on March 29.

“Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression,” the study concluded.

Of course, they urged additional study because “few trials on depression prevention have been done in primary care settings, although we believe this setting is ideal because so many patients receive primary care,” the study stated.

The study’s lead author, Juan Angel Bellon, tells Managed Care that “We could make an analogy with the prevention of cardiovascular diseases. No one doubts that most of it should be carried out in primary care and not by cardiologists. Primary prevention has to target healthy people, who have not yet developed the disease.”

Researchers looked at 70 PCP centers scattered over seven cities in Spain. Participants included 140 PCPs (70 in the control group and 70 in the intervention group) and 3,326 patients (1,663 each in the control and intervention groups). The study took place from October 2010 to February 2011.

The intervention group included running a 10- to 15-hour training workshop for PCPs; using a tool called predictD to measure a patient’s risk factors for getting depression; giving patients a booklet about how to prevent depression; educating patients about what to do when they detect signs of depression; and the assembling, by the PCP, of a bio-psycho-family-social intervention. This last involves patients answering questions about their mental and physical quality of life; whether they suffered from depression in the past or physical abuse in childhood; if he or she is currently taking medication for anxiety, stress or depression; dissatisfaction with living in the home, and dissatisfaction with unpaid work (basically, housework). It’s similar to trying to judge the chances of someone suffering a heart attack in the next 10 years, says Bellon.

“Once a PCP communicated the patient’s probability of depression, they discuss the risk factors that in particular might affect him or her,” says Bellon.

The study states that, “Patients in the control group continued to receive regular care, except that they were assessed for depression, anxiety, and other information at the same intervals as patients in the intervention group.”

After 18 months, 7.39% of intervention patients developed major depression, as opposed to 9.4% in the usual care group.

However, they did find that anxiety decreased in a significant way at 18 months for 2,998 patients. To calculate the new cases of anxiety disorder, researchers had to exclude 328 patients who had already suffered from the condition. They found that 10.4% in the intervention group developed it by 18 months, compared with 13.1% in the control group.