Epidemiology and natural history of depressive disorders in primary care
WY Chin
Department of Family Medicine and Primary Care, The University of Hong Kong
1. In Hong Kong’s primary care setting, the estimated prevalence of screen-positive depression is 10.7%, the 12-month incidence is 5.3%, and 12-month remission rate is 60.3%.
2. One in four patients with positive screening scores are identified as having depression by the primary care doctor. Patients with a history of depression or other mental health problems or who are non-Chinese are more likely to be identified by a doctor. Fortunately, most cases of depression are mild and self-limiting, and doctor identification does not appear to have any significant effect on resolution of symptoms or health-related quality of life at 1 year. Improvement in mental health-related quality of life is significantly greater in those who are identified by a doctor.
3. 12-month service utilisation rates for primary care doctors, psychiatrists, and psycho-social services are raised in patients who screen positive for depression and over the period of 12 months, at least one in five patients consulted a psychiatrist or psychiatric clinic.
4. Around 50% of patients identified as having depression by a doctor are treated with psychotropic medications. Over 1 year, one third of patients with positive screening scores for depression took psychotropic medications.
5. Counsellors appear to play an important adjunctive role in depression care. Improved access to psycho-social counselling services may help facilitate doctors to better manage depression, reduce the burden on specialist services, and potentially reduce medication use.