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Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach.
The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis.
We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales.
Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.
Mental disorders in the elderly are common, with a 12-month prevalence in the community ranging from 8.54% to 26.4%. Unfortunately, many mental disorders are unrecognized, untreated, and associated with poor health outcomes. The aim of this paper is to describe the prevalence of mental disorders in the elderly primary care (PC) population and its associated factors by age groups.
Cross-sectional survey, conducted in 77 PC centers in Catalonia (Spain), 1,192 patients over 65 years old. The prevalence of mental disorders was assessed through face-to-face evaluations using the Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version (SCID-I-RV) and the Mini International Neuropsychiatric Interview (MINI); chronic physical conditions were noted using a checklist; and disability through the Sheehan Disability Scales (SDS).
Nearly 20% of participants had a mental disorder in the previous 12 months. Anxiety disorders were the most frequent, (10.9%) (95% CI = 8.2–14.4), followed by mood disorders (7.4%) (95% CI = 5.7–9.5). Being female, greater perceived stress and having mental health/emotional problems as the main reason for consultation were associated with the presence of any mental disorder. There were no differences in prevalence across age groups. Somatic comorbidity was not associated with the presence of mental disorders.
Mental disorders are highly prevalent among the elderly in PC in Spain. Efforts are needed to develop strategies to reduce this prevalence and improve the well-being of the elderly. Based on our results, we thought it might be useful to assess perceived stress regularly in PC, focusing on people who consult for emotional distress, or that have greater perceived stress.
Within the ICD and DSM review processes there is growing debate on the
future classification and status of adjustment disorders, even though
evidence on this clinical entity is scant, particularly outside
To estimate the prevalence of adjustment disorders in primary care; to
explore whether there are differences between primary care patients with
adjustment disorders and those with other mental disorders; and to
describe the recognition and treatment of adjustment disorders by general
Participants were drawn from a cross-sectional survey of a representative
sample of 3815 patients from 77 primary healthcare centres in Catalonia.
The prevalence of current adjustment disorders and subtypes were assessed
face to face using the Structured Clinical Interview for DSM-IV Axis I
Disorders (SCID-I). Multilevel logistic regressions were conducted to
assess differences between adjustment disorders and other mental
disorders. Recognition and treatment of adjustment disorders by GPs were
assessed through a review of patients' computerised clinical
The prevalence of adjustment disorders was 2.94%. Patients with
adjustment disorders had higher mental quality-of-life scores than
patients with major depressive disorder but lower than patients without
mental disorder. Self-perceived stress was also higher in adjustment
disorders compared with those with anxiety disorders and those without
mental disorder. Recognition of adjustment disorders by GPs was low: only
2 of the 110 cases identified using the SCID-I were detected by the GP.
Among those with adjustment disorders, 37% had at least one psychotropic
Adjustment disorder shows a distinct profile as an intermediate category
between no mental disorder and affective disorders (depression and
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