Select Journal or Resource JAMA & Archives Home JAMA Archives of   Dermatology   Facial Plastic Surgery   Family Medicine (1992-2000)   General Psychiatry   Internal Medicine   Neurology   Neurology and Psychiatry (1919-1959)   Ophthalmology   Otolaryngology—Head & Neck Surgery   Pediatrics & Adolescent Medicine   Surgery JAMA-français JAMA & Archives CME Calendar of Events JAMA Career Center For The Media JAMAevidence Peer Review Congress Student JAMA (1998-2004)

	Institution: CLOCKSS  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 4 No. 2, February 1995   Archives  •  Online Features Original Contributions  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal Recognition, Management, and Outcomes of Depression in Primary Care Gregory E. Simon, MD, MPH; Michael VonKorff, ScD Arch Fam Med. 1995;4(2):99-105. Abstract Objective To evaluate the recognition, management, and outcomes of depressed patients presenting in primary care. Design Epidemiologic survey with 12-month follow-up. Setting Primary care clinics of a staff-model health maintenance organization. Patients and Main Outcome Measures Consecutive primary care attenders aged 18 to 65 years (n=1952) were screened using the 12-item General Health Questionnaire (GHQ-12), and a stratified random sample (n=373) completed a psychiatric assessment, including the Composite International Diagnostic Interview (CIDI), the 28-item GHQ, and a brief self-rated disability questionnaire (BDQ). Three-month follow-up assessment (n=347) repeated the GHQ-28 and BDQ, and 12-month follow-up (n=308) repeated the CIDI, GHQ-28, and BDQ. Use of psychotropic drugs and mental health services was assessed using computerized pharmacy and visit registration records. Results Structured interviews found 64 cases of current major depression (weighted prevalence, 6.6%) and 58 cases of current subthreshold depression (weighted prevalence, 8.8%). Of those with major depression, 64% (n=41) were recognized as psychologically distressed by the primary care physician, 56% (n=36) filled at least one antidepressant prescription during the next 3 months, and 39% (n=25) made at least one specialty mental health visit. Compared with recognized cases, those with unrecognized major depression were less symptomatic at baseline (GHQ-28 score, 15.31 vs 11.07; P=.006) but showed a similar rate of improvement over 12 months (F test for difference in slopes, P=.93). Conclusions While many depressed primary care patients may go unrecognized and untreated, this group appears to have milder and more self-limited depression. A narrow focus on increased recognition may not improve overall outcomes. Treatment resources might be best directed toward more intensive follow-up and relapse prevention among those now treated. Author Affiliations From the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Wash. THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Diagnostic Accuracy of Spanish Language Depression-Screening Instruments Reuland et al. Ann Fam Med 2009;7:455-462. ABSTRACT | FULL TEXT   Management of Psychosocial Distress by Oncologists Muriel et al. Psychiatr. Serv. 2009;60:1132-1134. ABSTRACT | FULL TEXT   Depression and Costs of Health Care Welch et al. Psychosomatics 2009;50:392-401. ABSTRACT | FULL TEXT   Adapted Behavior Therapy for Persistently Depressed Primary Care Patients: An Open Trial Uebelacker et al. Behav Modif 2009;33:374-395. ABSTRACT   Prevalence of diagnosed depression in South Asian and white European people with type 1 and type 2 diabetes mellitus in a UK secondary care population Ali et al. Postgrad. Med. J. 2009;85:238-243. ABSTRACT | FULL TEXT   Depression, cardiac mortality and all-cause mortality Seymour and Benning Adv. Psychiatr. Treat. 2009;15:107-113. ABSTRACT | FULL TEXT   Incidence and Recurrence of Late-Life Depression Luijendijk et al. Arch Gen Psychiatry 2008;65:1394-1401. ABSTRACT | FULL TEXT   Prevalence of depression and anxiety in patients requesting physicians' aid in dying: cross sectional survey Ganzini et al. BMJ 2008;337:a1682-a1682. ABSTRACT | FULL TEXT   Effect of Race/Ethnicity and Persistent Recognition of Depression on Mortality in Elderly Men With Type 2 Diabetes and Depression Richardson et al. Diabetes Care 2008;31:880-881. ABSTRACT | FULL TEXT   Screening and case-finding instruments for depression: a meta-analysis Gilbody et al. CMAJ 2008;178:997-1003. ABSTRACT | FULL TEXT   Effectiveness of a Time-Limited Cognitive Behavior Therapy Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms Escobar et al. Ann Fam Med 2007;5:328-335. ABSTRACT | FULL TEXT   Outcome and Impact of Mental Disorders in Primary Care at 5 years Jackson et al. Psychosom. Med. 2007;69:270-276. ABSTRACT | FULL TEXT   Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis Gaynes et al. Ann Fam Med 2007;5:126-134. ABSTRACT | FULL TEXT   A Qualitative Study of Depression in Primary Care: Missed Opportunities for Diagnosis and Education Saver et al. J Am Board Fam Med 2007;20:28-35. ABSTRACT | FULL TEXT   Collaborative care for depression in primary care: Making sense of a complex intervention: systematic review and meta-regression Bower et al. Br. J. Psychiatry 2006;189:484-493. ABSTRACT | FULL TEXT   Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes Gilbody et al. Arch Intern Med 2006;166:2314-2321. ABSTRACT | FULL TEXT   Rapid screening for major depression in post-myocardial infarction patients: an investigation using Beck Depression Inventory II items Huffman et al. Heart 2006;92:1656-1660. ABSTRACT | FULL TEXT   Depression decision support in primary care: a cluster randomized trial. Dobscha et al. ANN INTERN MED 2006;145:477-487. ABSTRACT | FULL TEXT   Effects of Depression on Sleep Quality, Fatigue, and Sleepiness in Persons With Restless Legs Syndrome Cuellar et al. J Am Psychiatr Nurses Assoc 2006;12:262-271. ABSTRACT   Changing Profiles of Service Sectors Used for Mental Health Care in the United States Wang et al. Am. J. Psychiatry 2006;163:1187-1198. ABSTRACT | FULL TEXT   Mothers and Primary Care Medicine: In Reply Elwy Pediatrics 2006;117:2323-2324. FULL TEXT   Should we screen for depression? Gilbody et al. BMJ 2006;332:1027-1030. FULL TEXT   Economic Grand Rounds: Improving the Quality of Depression Care in Medicaid Barry and Thomas Psychiatr. Serv. 2005;56:1193-1195. FULL TEXT   Specific Effects of Depression, Panic, and Somatic Symptoms on Illness Behavior Rief et al. Psychosom. Med. 2005;67:596-601. ABSTRACT | FULL TEXT   Can Doctors and Nurses Recognize Depression in Patients Hospitalized With an Acute Myocardial Infarction in the Absence of Formal Screening? Ziegelstein et al. Psychosom. Med. 2005;67:393-397. ABSTRACT | FULL TEXT   Depression Treatment in Primary Care Robinson et al. J Am Board Fam Med 2005;18:79-86. ABSTRACT | FULL TEXT   Treatment Outcome and Physician-Patient Communication in Primary Care Patients With Chronic, Recurrent Depression Schwenk et al. Am. J. Psychiatry 2004;161:1892-1901. ABSTRACT | FULL TEXT   Review: disease management programmes improve detection and care of people with depression Gilbody Evid. Based Ment. Health 2004;7:80-80. FULL TEXT   Moving Treatment Research From Clinical Trials to the Real World Roy-Byrne et al. Focus 2004;2:410-415. ABSTRACT | FULL TEXT   Depression: are we ignoring an important comorbidity in heart failure? O'Connor and Joynt J Am Coll Cardiol 2004;43:1550-1552. FULL TEXT   Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care Little et al. BMJ 2004;328:441. ABSTRACT | FULL TEXT   The Value of Pseudoneurological Symptoms for Assessing Psychopathology in Primary Care Interian et al. Psychosom. Med. 2004;66:141-146. ABSTRACT | FULL TEXT   A Physician's Suicide Hendin et al. Am. J. Psychiatry 2003;160:2094-2097. FULL TEXT   Educational and Organizational Interventions to Improve the Management of Depression in Primary Care: A Systematic Review Gilbody et al. JAMA 2003;289:3145-3151. ABSTRACT | FULL TEXT   Confronting Depression and Suicide in Physicians: A Consensus Statement Center et al. JAMA 2003;289:3161-3166. ABSTRACT | FULL TEXT   Aligning Incentives in the Treatment of Depression in Primary Care With Evidence-Based Practice Frank et al. Psychiatr. Serv. 2003;54:682-687. ABSTRACT | FULL TEXT   Improving the detection and management of depression in primary care Gilbody et al. Qual Saf Health Care 2003;12:149-155. ABSTRACT | FULL TEXT   Moving Treatment Research From Clinical Trials to the Real World Roy-Byrne et al. Psychiatr. Serv. 2003;54:327-332. ABSTRACT | FULL TEXT   The Effect of Volunteer Home Visitation for Adolescent Mothers on Parenting and Mental Health Outcomes: A Randomized Trial Barnet et al. Arch Pediatr Adolesc Med 2002;156:1216-1222. ABSTRACT | FULL TEXT   Screening for Depression: Recommendations and Rationale U.S. Preventive Services Task Force* ANN INTERN MED 2002;136:760-764. ABSTRACT | FULL TEXT   Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force Pignone et al. ANN INTERN MED 2002;136:765-776. ABSTRACT | FULL TEXT   Dimensional perspective on the recognition of depressive symptoms in primary care: The Hampshire Depression Project 3 THOMPSON et al. Br. J. Psychiatry 2001;179:317-323. ABSTRACT | FULL TEXT   Cost-effectiveness of Practice-Initiated Quality Improvement for Depression: Results of a Randomized Controlled Trial Schoenbaum et al. JAMA 2001;286:1325-1330. ABSTRACT | FULL TEXT   Primary Care Physicians' Experience With Mental Health Consultation Kushner et al. Psychiatr. Serv. 2001;52:838-840. ABSTRACT | FULL TEXT   The Cost-Utility of Screening for Depression in Primary Care Valenstein et al. ANN INTERN MED 2001;134:345-360. ABSTRACT | FULL TEXT   Screening the Public for Depression Through the Internet Houston et al. Psychiatr. Serv. 2001;52:362-367. ABSTRACT | FULL TEXT   The Electronic Medical Record: A Randomized Trial of Its Impact on Primary Care Physicians' Initial Management of Major Depression Rollman et al. Arch Intern Med 2001;161:189-197. ABSTRACT | FULL TEXT   Social, Cultural, and Clinical Dimensions of Traumatic Experiences of Primary Care Patients Palinkas Arch Fam Med 2000;9:812-813. FULL TEXT   Locus of Mental Health Treatment in an Integrated Service System Druss and Rosenheck Psychiatr. Serv. 2000;51:890-892. ABSTRACT | FULL TEXT   Randomized Trial of a Depression Management Program in High Utilizers of Medical Care Katzelnick et al. Arch Fam Med 2000;9:345-351. ABSTRACT | FULL TEXT   The Role of Competing Demands in the Treatment Provided Primary Care Patients With Major Depression Rost et al. Arch Fam Med 2000;9:150-154. ABSTRACT | FULL TEXT   Major Depression and Its Response to Sertraline in Primary Care vs. Psychiatric Office Practice Patients: Results of an Open-Label Trial in Argentina Lyketsos et al. Psychosomatics 1999;40:70-75. ABSTRACT | FULL TEXT   Primary Care Physicians' Approach to Depressive Disorders: Effects of Physician Specialty and Practice Structure Williams et al. Arch Fam Med 1999;8:58-67. ABSTRACT | FULL TEXT   Relapse of Depression in Primary Care: Rate and Clinical Predictors Lin et al. Arch Fam Med 1998;7:443-449. ABSTRACT | FULL TEXT   False Positives, False Negatives, and the Validity of the Diagnosis of Major Depression in Primary Care Klinkman et al. Arch Fam Med 1998;7:451-461. ABSTRACT | FULL TEXT   Managing Our Depressed Patients: Gold Standards vs Higher Standards Block Arch Fam Med 1998;7:462-464. FULL TEXT   Management of Patients With Depression by Rural Primary Care Practitioners Hartley et al. Arch Fam Med 1998;7:139-145. ABSTRACT | FULL TEXT   The 'Usual Care' of Major Depression in Primary Care Practice Schulberg et al. Arch Fam Med 1997;6:334-339. ABSTRACT   The National Depressive and Manic-Depressive Association Consensus Statement on the Undertreatment of Depression Hirschfeld et al. JAMA 1997;277:333-340. ABSTRACT   RECOGNITION AND MANAGEMENT OF DEPRESSION IN PRIMARY CARE JWatch General 1995;1995:10-10. FULL TEXT   The Blues: Now and Forever More? Bowman Arch Fam Med 1995;4:95-96. ABSTRACT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1995 American Medical Association. All Rights Reserved.