Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study

BMC Psychiatry

Research Article

Mitsuhiko Yamada¹  Akiyoshi Saitoh¹  Tsuyuka Ohtsuki¹  Masatoshi Inagaki²  Mie Kurosawa³  Yuetsu Oikawa⁴  Kumiko Muramatsu⁵ 

[1] Department of Psychogeriatrics, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira City, Tokyo, Japan;Department of Psychogeriatrics, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira City, Tokyo, Japan;Section of Medical Research for Suicide, Center for Suicide Prevention, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira City, Tokyo, Japan;Iwate Mental Health Center, Morioka CityIwate, Japan;Oshu City Magokoro Hospital, Oshu City, Iwate, Japan;The Clinical Psychology Course, Graduate School of Niigata Seiryo University, Niigata City, Niigata, Japan;

关键词: Depressed Patient;    Recognition Rate;    Mood Disorder;    Major Depressive Disorder;    General Internist;   

DOI  :  10.1186/1471-244X-10-30

 received in 2010-02-15, accepted in 2010-04-26,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundA general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital.MethodsPatients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ). Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records.ResultsAmong 312 patients, 27 (8.7%) and 52 (16.7%) were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8%) were recognized by physicians as having a mental disorder, but only three (11.1%) were diagnosed as having a mood disorder.Only two patients with major depressive disorder (7.4%) had been prescribed antidepressants. Even among those (n = 15) whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7%) were prescribed an antidepressant.ConclusionsDespite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring patients to mental health specialists.

【 授权许可】

Unknown   
© Ohtsuki et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.