A Controlled, Follow-up Study On The Recognition And Management Of Depression In Psychiatric Department In General Hospitals

Objective: By investigating the current situation about the recognition of depression by psychiatrists and non-psychiatrists in psychiatric department in general hospitals, and the analysis of related influential factors, the study is aimed to provide corresponding basis for constituting policy on mental health service in general hospitals.Methods: 1. 680 outpatients first consulting in psychiatric clinics among 9 general hospitals in Shanghai were surveyed in the study. These patients were screened by the investigators using International Classification of disease-10 (ICD-10) diagnostic criteria for depressive disorder and Composite International Diagnostic Interview (CIDI) findings tool on their first visit day. And those who were diagnosed as depressive disorders by the two tools were involved in the study. Also the investigators checked the accuracy of diagnosis making by psychiatrists or non-psychiatrists who treated those patients during their course. The depressive patients who did not recognized by the psychiatrists or non-psychiatrists, that is, the diagnosis was inconsistent with the ICD-10 and CIDI tools were also admitted in the study. Thus, 270 depressive patients altogether were included in the study among which 253 cases finished the total follow-up. Those 253 cases were divided into psychiatrists treated group and non-psychiatrists treated group, 161 and 92 respectively. 2. All the cases in the two groups were assessed with Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Clinical Global Impression (CGI), the Medical Outcomes Study Short form 36(SF-36), Social Disability Screening Schedule (SDSS), as well as some self-made questionnaires in the first interview, two weeks, four weeks, eight weeks and twelve weeks flow-up interviews to evaluate therapeutic effect. A self-made questionnaire was used to assess the non-psychiatrists' ability in the recognition of depression in order to acquire the related factors which might influence the recognition of depression. 3. Statistical approaches such as t test,anova analysis,Person'sχ~2 statistics, Logistic regression analysis,measure of agreement Kappa test,McNemar nonparametric statistics and so on were employed to analyze the data according to the characteristic of the distribution of data. The statistical software used throughout the analysis was SPSS11.5. Results: 1. The general social- demographic materials: The female accounted for the majority in the samples, and the gender ratio was 2.2. The average age was (43.0±12.5) years old, the average course of disease was (36.1±60.6) months, the average amount of disease episode was(2.4±5.2). There had no significant difference in age, gender, education, family condition, family financial burden, character, total course of depression, the inducement, chronic medical condition, family history between psychiatrists treated group and non-psychiatrists treated group. 2. The assessment for the diagnosis of depression in two groups: The psychiatrists had much more efficiency in the recognition of depression than the non-psychiatrists in general psychiatric practice (χ~2=32.54, P=0.000). The rate of depression recognition is 92.2% vs 68.4%. But the rate of error in depression recognition by non-psychiatrists is as high as 73.3%. The agreement between psychiatrists' diagnosis and CIDI findings is consistent (Kappa=0.72), while for non-psychiatrists and CIDI, the result is inconsistent(Kappa=0.039). 3. The difference of curative effect in two groups: According to HAMD score reduction rate, the curative effect in psychiatrists treated group is greatly superior to the latter after 8-week and 12-week treatment (the 8-week:χ~2=26.7, P=0.000; 12-week:χ~2=36.7, P=0.000). 88% patients in psychiatrists treated group got "cure" after 12 weeks therapy, while only 54% in non-psychiatrists treated group. There were statistically significant differences in the improvement of HAMD, HAMA total score reduction rate and some factors score reduction rate after 4-week, 8-week and 12-week treatment between the two groups(P＜0.01). The HAMD scores decreased greatly during the 4-week, 8-week and 12-week flow-up interviews compared to the first interview for both of the group (P＜0.01), and also the psychiatrists treated group was much more effective than the non-psychiatrists treated group. (P＜0.01). As for the social function and the quality of life, there was a significant improve in SDSS score, the three factors score for physical functioning, vitality, role of emotion in SF-36 after 12-week treatment between the two groups(P＜0.01). 4. The analysis of the influential factors on the recognition of depression for the non-psychiatrists: the longer time they worked on the psychiatricpractice, the more training they were received to cope with mental disorders, the higher recognition of depression were. So the two factors influence the recognition of depression for the non-psychiatrists significantly. The odds ratio (OR) is 1.453, 2.020 respectively.Conclusion: 1. The most common mental health disorder in general hospitals is depression. And the prevalence of depression is 39.7%; 2. The non-psychiatrists' ability to recognize depression in psychiatric department of general hospitals is much more insufficient than the psychiatrists in Shanghai. In about 21.6% of depressed patients consulting the non-psychiatrists, the non-psychiatrists do not recognize that the patients may suffer from a mental health problem and 73.3% of the patients are not gain the correct diagnosis by non-psychiatrists. The work time and the training for the management of mental disorders are relevant to the recognition of depression, which are the main factors in judging the non-psychiatrists' ability to cope with mental disorders; 3. It is different for the psychiatrists and non-psychiatrists in the therapeutic pattern in coping with depressive disorder. The psychiatrists are more effective in improving the therapeutic effect, the social functioning and the quality of life of the depressed patients than the non-psychiatrists in general hospitals. More efforts must be imposed to improve the recognition and diagnosis of depression by the non-psychiatrists in general psychiatric practice; 4. Our study suggests that it is important to emphasize the management of the staffs in psychiatric settings in general hospitals. And the difference in the recognition and treatment of depression between the psychiatrists and non-psychiatrists may provide an objective basis on how to strengthen the role of the mental health service system for its effective management in general hospitals.