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The influence of specific chronic somatic conditions on the care for co-morbid depression in general practice

Published online by Cambridge University Press:  10 September 2007

J. Nuyen ,
P. M. Spreeuwenberg ,
L. Van Dijk ,
G. A. M. Van den Bos ,
P. P. Groenewegen  and
F. G. Schellevis
J. Nuyen*
Affiliation:
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
P. M. Spreeuwenberg
Affiliation:
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
L. Van Dijk
Affiliation:
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
G. A. M. Van den Bos
Affiliation:
Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
P. P. Groenewegen
Affiliation:
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
F. G. Schellevis
Affiliation:
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands Department of General Practice/EMGO Institute, VU University Medical Centre, VU University Amsterdam, The Netherlands
*
*Address for correspondence: J. Nuyen, M.Sc., NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, PO Box 1568, 3500 BN Utrecht, The Netherlands/Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, PO Box 725, 3500 AS Utrecht, The Netherlands. (Email: jnuijen@trimbos.nl)
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Abstract

Background

Limited information exists on the relationship between specific chronic somatic conditions and care for co-morbid depression in primary care settings. Therefore, the present prospective, general practice-based study examined this relationship.

Method

Longitudinal data on morbidity, prescribing and referrals concerning 991 patients newly diagnosed with depression by their general practitioner (GP) were analysed. The influence of a broad range of 13 specific chronic somatic conditions on the initiation of any depression care, as well as the prescription of continuous antidepressant therapy for 180 days, was examined. Multilevel logistic regression analysis was used to control for history of depression, psychiatric co-morbidity, sociodemographics and interpractice variation.

Results

Multilevel analysis showed that patients with pre-existing ischaemic heart disease (72.1%) or cardiac arrhythmia (59.3%) were significantly less likely to have any depression care being initiated by their GP than patients without chronic somatic morbidity (88.0%). No other specific condition had a significant influence on GP initiation of any care for depression. Among the patients being prescribed antidepressant treatment by their GP, none of the conditions was significantly associated with being prescribed continuous treatment for 180 days.

Conclusions

Our study indicates that patients with ischaemic heart disease or cardiac arrhythmia have a lower likelihood of GP initiation of any care for depression after being newly diagnosed with depression by their GP. This finding points to the importance of developing interventions aimed at supporting GPs in the adequate management of co-morbid depression in heart disease patients to reduce the negative effects of this co-morbidity.

Keywords

Chronic somatic diseaseco-morbid depressiongeneral practice
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 2 , February 2008 , pp. 265 - 277
Copyright
Copyright © Cambridge University Press 2007

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