To examine the care provided by general practitioners (GPs) for persistent depressive illness and its relationship to patient, illness and consultation characteristics.

Using the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC) a sample of 264 patients with ICD-10 depression was identified among consecutive primary care patients in the Netherlands. At 1-year follow-up 78 of these patients (30%) still fulfilled the criteria of an ICD-10 depression and were considered persistent cases. At baseline and follow-up the GPs specified their diagnosis and treatment. The extent of recognition as a mental health problem, accuracy of diagnosis as a depression and treatment in accordance with clinical guidelines for depression was examined. In addition it was examined whether these steps in adequate GP care for persistent depression were related to patient, illness and consultation characteristics.

Twenty percent of the persistent depression cases were not recognized at baseline or during follow-up, 28% was recognized but not accurately diagnosed, 17% was accurately diagnosed, but did not receive adequate treatment and 35% was treated adequately. Recognition was associated with psychological reason for encounter; accurate diagnosis with absence of activity limitation days; and adequate treatment with severity of depression and higher educational level.

Non-recognition, misdiagnosis and inadequate treatment are not limited to patients with a relatively mild and brief depression but are also prominent in patients with a persistent depression, who consulted their GP 8.2 times on average during the year their depression persisted.

Forensic psychiatry aims to reduce recidivism and makes use of risk assessment tools to achieve this goal. Various studies have reported on the predictive qualities of these instruments, but it remains unclear whether their use is associated with actual prevention of recidivism in clinical care.

To test whether an intervention combining risk assessment and shared care planning is associated with a reduction in violent and criminal behaviour.

A cluster randomised controlled trial (Netherlands Trial Register number NTR1042) was conducted in three outpatient forensic psychiatric clinics. The intervention comprised risk assessment with the Short Term Assessment of Risk and Treatability (START) and a shared care planning protocol formulated according to shared decision-making principles. The control group received usual care. The outcome consisted of the proportion of clients with violent or criminal incidents at follow-up.

In total 58 case managers and 632 of their clients were included, in the intervention group (n=310), 65% received the intervention at least once. Findings showed a general treatment effect (22% of clients with an incident at baseline v. 15% at follow-up, P<0.01) but no significant difference between the two treatment conditions (odds ratio (OR)=1.46, 95% CI 0.89-2.44, P = 0.15).

Although risk assessment is common practice in forensic psychiatry, our results indicate that the primary goal of preventing recidivism was not reached through risk assessment embedded in shared decision-making.

Patient–clinician communication is central to mental healthcare but neglected in research.

To test a new computer-mediated intervention structuring patient–clinician dialogue (DIALOG) focusing on patients' quality of life and needs for care.

In a cluster randomised controlled trial, 134 keyworkers in six countries were allocated to DIALOG or treatment as usual; 507 people with schizophrenia or related disorders were included. Every 2 months for 1 year, clinicians asked patients to rate satisfaction with quality of life and treatment, and request additional or different support. Responses were fed back immediately in screen displays, compared with previous ratings and discussed. Primary outcome was subjective quality of life, and secondary outcomes were unmet needs and treatment satisfaction.

Of 507 patients, 56 were lost to follow-up and 451 were included in intention-to-treat analyses. Patients receiving the DIALOG intervention had better subjective quality of life, fewer unmet needs and higher treatment satisfaction after 12 months.

Structuring patient–clinician dialogue to focus on patients' views positively influenced quality of life, needs for care and treatment satisfaction.

Examinar la atención que los médicos generales (MG) prestan a la enfermedad depresiva persistente y su relación con las características del paciente, la enfermedad y la consulta

Utilizando la Entrevista Diagnóstica Internacional Compuesta-Versión de Atención Primaria (CIDI-PHC), se identificó una muestra de 264 pacientes con depresión de la CIE-10 entre pacientes de atención primaria consecutivos en los Países Bajos. En el seguimiento al año, 78 de estos pacientes (30%) cumplían todavía los criterios de depresión de la CIE-10 y se consideraron casos persistentes. Los MG especificaron su diagnóstico y tratamiento en la línea de base y el seguimiento. Se examinó en qué medida se reconocía como problema de salud mental, la precisión del diagnóstico como depresión y el tratamiento de acuerdo con las directrices clínicas para depresión. Además, se examinó si estos pasos en la atención adecuada del MG a la depresión persistente se relacionaban con las características del paciente, la enfermedad y la consulta.

El veinte por ciento de los casos de depresión persistente no se reconoció en la línea de base o durante el seguimiento; el 28% se reconoció, pero no se diagnosticó con precisión; el 17% tuvo un diagnóstico preciso, pero no recibió tratamiento adecuado, y 35% tuvo tratamiento adecuado. El reconocimiento se asociaba con una razón psicológica para el encuentro; el diagnóstico preciso, con la ausencia de días de limitación de actividad, y el tratamiento adecuado, con la gravedad de la depresión y un nivel educativo más alto.

La ausencia de reconocimiento, el diagnóstico erróneo y el tratamiento inadecuado no se limitan a los pacientes con depresión relativamente leve y breve, sino que son prominentes también en los pacientes con depresión persistente, que consultaron a su MG 8,2 veces como media durante el año en que su depresión persistió.

A prognosis serves important functions for the management of common mental disorders in primary care.

To establish the accuracy of the general practitioner's (GP) prognosis.

The agreement between GP prognosis and observed course was determined for 138 cases of ICD–10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs.

Modest agreement between GP prognosis and course was found, both for depression (κ=0.21) and generalised anxiety (κ=0.111). Better agreement (κ=0.45 for depression, and κ=0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs.

General practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance.