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INTRODUCTION
In primary care the recognition of depression is often less than ideal. For
example, 50% of people with major depression, identified by independent
screening in GP waiting rooms, are not recognized as depressed by the doctor 1.
The recognition of depression is particularly dif ficult in certain patient groups
such as the physically ill.
There may be a number of possible reasons for a lack of recognition of
depression within primary care (see Figure 3.1). Generally these can be
summarized as fol lows:
3.patients ignore depression in themselves;
4.fear of the stigma of mental illness;
5.worry about side effects of medication;
6.misdiagnosis of somatic complaints;
7.overlooking of depression in those known to have a physical illness; and
8.blaming depression on circumstances, regarding it as ‘understandable’.
Unfortunately those patients who go unrecognized and untreated may
have poorer shortterm outcomes on measures of low mood, reduced
energy and irritability. However, recent research suggests that disclosure
of
depression in ‘unrecognized’ patients has little effect on overall outcome.
There are a number of key interview skills and cues that have been identified as
crucial to the recognition of depression (see Figures 3.2 and 3.3).
IS DEPRESSION MORE COMMON TODAY?
There is some evidence that the incidence of depression may have increased in
younger cohorts. A longterm followup study in Sweden (the Lundby Study) 2
found a marked increase in incidence rates in the 1960s and 1970s, and a ten
fold increase in the incidence for men aged 20–39 years, for the period of 1957–
1972 com pared to 1947–1957, although this may be due to a limited amount of
data before the 1960s, against which to make a valid comparison. Although
there have been several studies that indicate a recent rise in the inci dence and
prevalence of depression, this remains fairly controversial due to methodologic
problems in data collection, particularly the recall bias for remembering
symptoms from more recent years.