Depression is one of the most common disorders among patients in family practice. Unfortunately, they are often difficult to detect because they may be masked by somatic symptoms or the patient may present with only these. Especially if the symptoms cannot be fully explained from the somatic findings, depression should always be considered.
In general, patients should always be asked about their mental health in their primary care physician’s office so that these common conditions are not overlooked. Often patients are very relieved about such a question, because they are afraid to talk spontaneously about their feelings. Men in particular sometimes have difficulties with this.
In a study conducted in Western Switzerland with the collaboration of 24 primary care physicians [1], physicians asked participating patients two simple questions to identify depression:
- “In the past month, have you often been sad, depressed, despondent?”
- “In the past month, have you had less interest and desire in most of the activities you usually enjoy?”
These two questions were sufficient to identify major depression in nine out of ten cases. This was the case for 9.5% of patients who visited their primary care physician for somatic complaints.
It is important for primary care physicians to refer patients with treatment-resistant depressive disorders to a psychiatric specialist – for further evaluation and treatment recommendations, or to take over further treatment. Unfortunately, psychiatry is still stigmatized among large segments of the population, as are mental illnesses. If, however, a family doctor explains the disease to his patients well and makes referrals as a matter of course as he does to other specialists, the patient will usually experience this as competent and helpful.
Literature:
- Lombardo P, et al: The ‘help’ question doesn’t help when screening for major depression: external validation of the three-question screening.test for primary care patients managed for physical complaints. BMC Med 2011; 9: 114.
