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Recent trends in the incidence of recorded depression in primary care

  • Greta Rait (a1), Kate Walters (a2), Mark Griffin (a2), Marta Buszewicz (a2), Irene Petersen (a2) and Irwin Nazareth (a3)...
Abstract
Background

There is a paucity of data describing how general practitioners (GPs) label or record depression.

Aims

To determine incidence and sociodemographic variation in GP-recorded depression diagnoses and depressive symptoms.

Method

Annual incidence rates calculated using data from 298 UK general practices between 1996 and 2006, adjusted for year of diagnosis, gender, age and deprivation.

Results

Incidence of diagnosed depression fell from 22.5 to 14.0 per 1000 person-years at risk (PYAR) from 1996 to 2006. The incidence of depressive symptoms rose threefold from 5.1 to 15.5 per 1000 PYAR. Combined incidence of diagnoses and symptoms remained stable. Diagnosed depression and symptoms were more common in women and in more deprived areas.

Conclusions

Depression recorded by general practitioners has lower incidence rates than depression recorded in epidemiological studies, although there are similar associations with gender and deprivation. General practitioners increasingly use symptoms rather than diagnostic labels to categorise people's illnesses. Studies using standardised diagnostic instruments may not be easily comparable with clinical practice.

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Copyright
Corresponding author
Dr Greta Rait, MRC General Practice Research Framework, Stephenson House, 158–160 North Gower Street, London NW1 2ND, UK. Email: g.rait@pcps.ucl.ac.uk
Footnotes
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The Department of Primary Care and Population Health, University College London holds a license to conduct analysis on THIN. The Departmental THIN/GPRD Executive Committee reviewed and approved the study protocol, but had no involvement in the analysis, interpretation or decision to submit for publication. K.W. and I.P. were supported by a Special Training Fellowship in Health Services Research from the Medical Research Council (UK). This sponsor had no involvement in the study design, data collection, analysis, interpretation or decision to submit for publication.

Declaration of interest

None.

Footnotes
References
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Recent trends in the incidence of recorded depression in primary care

  • Greta Rait (a1), Kate Walters (a2), Mark Griffin (a2), Marta Buszewicz (a2), Irene Petersen (a2) and Irwin Nazareth (a3)...
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eLetters

�Depression� and the medicalisation of misery

derek a summerfield, psychiatrist
02 December 2009

Rait et al found that since 1996 a fall in the incidence of recorded depression in UK general practice has been offset by a threefold increase in the incidence of recorded depressive symptoms, with the combined incidence remaining much the same. (1) They discuss possible changes in GPs’ recording behaviour. Surely the most spectacular change in GP behaviour has been in antidepressant prescribing, which in this period hasalso risen nearly threefold. Currently running to 30 million prescriptions annually, this has moved beyond medicine to be an emergent cultural phenomenon.(2) In USA one in eight of the entire adult population reportedly takes an SSRI anti-depressant in a year.

It is certainly fair comment for the authors to note that the evidence is contested that the identification of depression in clinical practice leads to better long-term outcomes. A WHO study in 15 cities around the world found that those whose ‘depression’ was recognised by doctors did slightly worse than the ‘depressed’ who were not recognised. (3) The British Journal of Psychiatry reported a study of 18,414 patientsattending 55 GP practices in Hampshire, in which 48% of the variance between practices in the recorded prevalence of depressive symptoms was accounted for by a measure of socio-economic deprivation. (4) What did these people really need?

GPs are medicalising everyday misery, surely, yet the Royal College of Psychiatrists has promoted the notion that they under-recognise depression. Rait et found a combined incident rate of recorded depressionin UK general practice (diagnoses and symptoms) of 2.5%; as the authors note, this is markedly lower than the rates psychiatric epidemiologists tend to produce(and which were traded on in the ‘Defeat Depression’ campaign, for example). Thus, regarding over-medicalisation, how much more might a finger be pointed at the psychiatric profession in its contributions to the debate about ‘depression’ and its social policy implications? This would be a challenge to its research methodologies and clinical nous.

1Rait G, Walters K, Griffin M, Buzewicz M, Petersen I, Nazareth I. Recent trends in the incidence of recorded depression in primary care. Br J Psychiatry 2009; 195: 520-24.2Summerfield D. Depression: epidemic or pseudo-epidemic? J Royal Soc Med 2006; 99: 161-2.3Goldberg D, Privett M, Ustun B, Simon G, Linden M. The effects of detection and treatment on the outcome of major depression in primary care: a naturalistic study in 15 cities. Br J Gen Pract 1998; 48; 1840-4.4Ostler K, Thompson C, Kinmouth A-LK, Peveler RC, Stevens L, Stevens A. Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care. The Hampshire Depression Project. Br J Psychiatry 2001; 178: 12-17.

Derek Summerfield South London and Maudsley Trust, and Institute ofPsychiatry, King’s College London. Address: 5 Windsor Walk, London SE5 8BB.Tel 020 3228 5121Fax 020 3228 5302Email: derek.summerfield@slam.nhs.uk Declaration of interest: nil
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