Detección del trastorno depresivo mayor en atención primaria. Una revisión

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2015-07-01

Detección del trastorno depresivo mayor en atención primaria. Una revisión

Detection of major depressive disorder in primary care patients. A review

Palabras clave:

Depresión, trastorno depresivo, detección, tamizaje, atención primaria (es)
Depression, Depressive disorder, Detection, Screening, Primary care (en)

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Autores/as

José Manuel Calvo-Gómez Departamento de Psiquiatría, Facultad de Medicina. Universidad Nacional de Colombia. Bogotá, D.C., Colombia.
Luis Eduardo Jaramillo-González Departamento de Psiquiatría, Facultad de Medicina. Universidad Nacional de Colombia. Bogotá, D.C., Colombia.

Resumen (es)
Resumen (en)

Antecedentes. Distinguir entre los cambios que normalmente ocurren en el estado del ánimo y aquellos presentes en el trastorno depresivo no es una tarea fácil, por esta razón se han propuestos mecanismos e instrumentos para mejorar la detección de estos trastornos en pacientes de atención primaria.

Objetivos. Evaluar si la detección sistemática rutinaria con instrumentos de tamizaje, con o sin sistemas de seguimiento y manejo integrado, es más efectiva que la atención usual para identificar pacientes con depresión, facilitar su tratamiento, y mejorar los resultados clínicos en atención primaria.

Materiales y métodos. Se llevó a cabo una búsqueda de estudios de casos y controles, cohortes y controlados aleatorizados, revisiones sistemáticas, y meta-análisis en las bases de datos MEDLINE, Cochrane, PsycINFO, y EMBASE desde enero de 1976 hasta el 30 de abril de 2013.

Resultados. La evidencia mostró que muchos casos de depresión no son detectados. Los médicos de atención primaria (MAP) logran tasas de detección del trastorno depresivo entre el 30% y 40%, sin utilizar herramientas adicionales para el diagnóstico como las escalas de una, dos y tres preguntas. Los pacientes con síntomas menos severos y más jóvenes son los menos detectados.

Conclusiones. El tamizaje para depresión a nivel de atención primaria, con retroalimentación del resultado, puede incrementar el reconocimiento del trastorno por parte del MAP. Sin embargo, el efecto de la retroalimentación sobre el tratamiento y los resultados en cuanto a mejoría de los síntomas o remisión son muy pobres.

Background. The distinction between normal mood changes and mood changes related to the spectrum of depressive disorders is not an easy task. Hence, several mechanisms and tools to improve the detection of these disorders in primary health care have been designed and tested.

Objectives. To evaluate whether systematic detection with screening instruments, with or without monitoring and integrated management, is more effective than usual care to identify patients with depression, to facilitate their treatment and to improve clinical outcomes in primary care.

Materials and methods. A search of case-control studies, cohort studies and randomized controlled trials, systematic reviews and meta-analyses in MEDLINE, Cochrane, PsycINFO, and EMBASE was carried out between January 1976 and April 30, 2013.

Results. The evidence showed that many cases of depression were not detected. The detection rates of depressive disorder by primary care physicians was between 30% and 40% (range 7-70%), when they proceeded without using additional tools for the diagnosis such as scales of one, two or three questions. Younger patients and with less severe symptoms were those less detected.

Conclusions. The screening for depression in primary care with feedback can increase the recognition of the disorder by primary health care physicians. However, the effect of feedback on the treatment and outcomes, in terms of clinical improvement or remission is very poor.

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Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, Vos T, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med. 2013;43(3):471-481. http://doi.org/5jk.

Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, De Girolamo G, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9:90. http://doi.org/cxhbb6.

República de Colombia, Ministerio de la Protección Social, Fundación FES. Estudio Nacional de Salud Mental Colombia 2003. Cali: Ministerio de la Protección Social-Fundación FES; 2005.

Organización Mundial de la Salud. Informe sobre la salud en el mundo 2001-Salud mental: nuevos conocimientos, nuevas esperanzas. Ginebra: OMS; 2001.

World Health Organization N. The global burden of disease: 2004 update.; Geneve: WHO; 2008.

Ormel J, Vonkorff M, Oldehinkel AJ, Simon G, Tiemens BG, Ustün TB. Onset of disability in depressed and non-depressed primary care patients. Psychol Med. 1999;29(4):847-853. http://doi.org/cb5g9c.

Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007; 370(9590):851-858. http://doi.org/fsn87k.

Cassano P, Fava M. Depression and public health: An overview. J Psychosom Res. 2002;53(4):849-857. http://doi.org/c59jf8.

Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146538 participants in 54 observational studies. Eur Heart J. 2006; 27(23):2763-2774. http://doi.org/csnc8c.

Sartorius N. The economic and social burden of depression. J Clin Psychiatry. 2001;62(1 Suppl):8-11.

Bostwick JM, Pankratz VS. Affective disorders and suicide risk: a reexamination. Am J Psychiatry. 2000; 157(12):1925-1932. http://doi.org/bg3vbg.

Ramchandani P. The impact of parental psychiatric disorder on children. BMJ. 2003; 327:242-243. http://doi.org/dqbd5r.

Wittchen HU, Schuster P, Lieb PSR. Comorbidity and mixed anxiety-depressive disorder: Clinical curiosity or pathophysiological need? Hum Psychopharmacol. 2001; 16(1 Suppl):S21-S30. http://doi.org/cknsnj.

Andrews G, Anderson TM, Slade T, Sunderland M. Classification of anxiety and depressive disorders: Problems and solutions. Depression and Anxiety. 2008; 25(4):274-281. http://doi.org/brjhjw.

Williams JW, Pignone M, Ramírez G, Pérez C. Identifying depression in primary care: A literature synthesis of case-finding instruments. Gen Hosp Psychiatry. 2002; 24(4):225-237. http://doi.org/b72xr6.

Gilbody S, Sheldon T, Wessely S. Should we screen for depression? BMJ. 2006; 332(7548):1027-1030. http://doi.org/czvdmd.

Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997; 12(7):439-445. http://doi.org/fs2nbn.

Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. 2003; 327(7424):1144-1146. http://doi.org/fhqqkg.

Arroll B, Goodyear-Smith F, Kerse N, Fishman T, Gunn J. Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study. BMJ. 2005; 331(7521):884. http://doi.org/ftw5s4.

Williams JW, Mulrow CD, Kroenke K, Dhanda R, Badgett RG, Omori D, et al. Case-finding for depression in primary care: a randomized trial. Am J Med. 1999; 106(1): 36-43. http://doi.org/cpgcb3.

Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999; 282(18):1737-1744. http://doi.org/b9xrff.

Reuland DS, Cherrington A, Watkins GS, Bradford DW, Blanco RA, Gaynes BN. Diagnostic Accuracy of Spanish Language Depression-Screening Instruments. Ann Fam Med. 2009; 7(5):455-62. http://doi.org/fnkgjp.

Campo A, Díaz LA, Rueda GE, Barros JA. Validación de la escala de Zung para depresión en universitarias de Bucaramanga, Colombia. Rev Colomb Psiquiatr. 2005; 34(1):54-62.

Rico J, Restrepo M, Molina M. Adaptación y validación de la escala hospitalaria de ansiedad y depresión (had) en una muestra de pacientes con cáncer del instituto nacional de cancerologia de colombia. Av en Medición. 2005; 3(1):73-86.

Villalobos FH. Estructura factorial y propiedades psicométricas de una escala de depresión en universitarios de Colombia. Rev Panam Salud Pública. 2010; 27(1):110-6. http://doi.org/bqqfnk.

Rueda GE, Díaz LA, López MT, Campo A. Validación de una versión abreviada de la Escala para Depresión del Centro de Estudios Epidemiológicos (CES-D) en adultos colombianos. Rev Colomb Psiquiatr. 2009; 38(3):513-521.

Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV 3rd, Hahn SR, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994; 272(22):1749-1756. http://doi.org/ddbphg.

Williams JW, Noël P, Cordes J, Ramírez G, Pignone M. Is this patient clinically depressed? JAMA. 2002; 287(9):1160-1170. http://doi.org/d8f3j6.

Del Piccolo L, Saltini A, Zimmermann C. Which patients talk about stressful life events and social problems to the general practitioner? Psychol Med. 1998; 28(6):1289-1299. http://doi.org/dg5m32.

Raine R, Lewis L, Sensky T, Hutchings A, Hirsch S, Black N. Patient determinants of mental health interventions in primary care. Br J Gen Pract. 2000;50(457):620-625.

Docherty JP. Barriers to the diagnosis of depression in primary care. J Clin Psychiatry. 1997;58(1 Suppl): S5-10.

Thompson C, Ostler K, Peveler RC, Baker N, Kinmonth AL. Dimensional perspective on the recognition of depressive symptoms in primary care: The Hampshire Depression Project 3. Br J Psychiatry. 2001; 179(4):317-323. http://doi.org/fhzfnd.

Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet. 2009; 374(9690):609-619. http://doi.org/bxkgvv.

Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003; 289(23):3095-3105. http://doi.org/cxq.

Kessler D, Bennewith O, Lewis G, Sharp D. Detection of depression and anxiety in primary care: follow up study. BMJ. 2002; 325(7371):1016-1017. http://doi.org/c9z45w.

Rogers Dianne Oliver, Anne CM. Experiencing depression, experiencing the depressed: The separate worlds of patients and doctors. J Ment Heal. 2001; 10(3):317-333. http://doi.org/dgtb98.

Gilbody SM, House AO, Sheldon TA. Routinely administered questionnaires for depression and anxiety: systematic review. BMJ. 2001; 322(7283):406-409. http://doi.org/cjkb3h.

Gilbody S, House AO, Sheldon TA. Screening and case finding instruments for depression. Cochrane Database Syst Rev. 2005,. http://doi.org/fmhmwk.

Gilbody S, Sheldon T, House A. Screening and case-finding instruments for depression: a meta-analysis. CMAJ. 2008; 178(8):997-1003. http://doi.org/cj2jz2.

Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002; 136(10):765-776. http://doi.org/5kg.

O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Intern Med. 2009; 151:793-803. http://doi.org/5wp.

U.S. Preventive Services Task Force. Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2009; 151(11):784-92. http://doi.org/5kh.

Katon W, von Korff M, Lin E, Bush T, Ormel J. Adequacy and duration of antidepressant treatment in primary care. Med Care. 1992; 30(1): 67-76. http://doi.org/dzw3dh.

Donoghue JM, Tylee A. The treatment of depression: prescribing patterns of antidepressants in primary care in the UK. Br J Psychiatry. 1996; 168(2):164-168. http://doi.org/fkv6p4.

Rost K, Humphrey J, Kelleher K. Physician management preferences and barriers to care for rural patients with depression. Arch Fam Med. 1994; 3(5):409-414. http://doi.org/fjtt3c.

Kendrick T, King F, Albertella L, Smith PW. GP treatment decisions for patients with depression: an observational study. Br J Gen Pract. 2005; 55(513):280-6.

Hoeper EW, Kessler LG, Nycz GR, Burke JD, Pierce WE. The usefulness of screening for mental illness. Lancet. 1984; 323(8367):33-35. http://doi.org/c8n9sj.

Dowrick C, Buchan I. Twelve month outcome of depression in general practice: does detection or disclosure make a difference? BMJ. 1995; 311(7015):1274-1276. http://doi.org/cmbtd4.

Lewis G, Sharp D, Bartholomew J, Pelosi AJ. Computerized assessment of common mental disorders in primary care: effect on clinical outcome. Fam Pract. 1996; 13(2):120-126. http://doi.org/dscpk3.

Weatherall M. A randomized controlled trial of the geriatric depression scale in an inpatient ward for older adults. Clin Rehabil. 2000; 14(2):186-191. http://doi.org/fk5h75.

Schriger DL, Gibbons PS, Langone CA, Lee S, Altshuler LL. Enabling the diagnosis of occult psychiatric illness in the emergency department: A randomized, controlled trial of the computerized, self-administered PRIME-MD diagnostic system. Ann Emerg Med. 2001; 37(2):132-140. http://doi.org/dw5q2r.

Bergus GR, Hartz AJ, Noyes R, Ward MM, James PA, Vaughn T, et al. The limited effect of sceening for depressive symptoms with the PHQ-9 in rural family practices. J Rural Heal. 2005; 21(4):303-309. http://doi.org/d3b3bv.

Johnstone A, Goldberg D. Psychiatric screening in general practice. A controlled trial. Lancet. 1976; 1(7960):605-8. http://doi.org/dx37xr.

Moore JT, Silimperi DR, Bobula JA. Recognition of depression by family medicine residents: the impact of screening. J Fam Pract. 1978; 7(3):509-13.

Linn LS, Yager J. Screening of depression in relationship to subsequent patient and physician behavior. Med Care. 1982; 20(12):1233-1240. http://doi.org/bj825r.

Zung WWK, Magill M, Moore JT, George DT. Recognition and treatment of depression in a family medicine practice. J Clin Psychiatry. 1983; 44(1):3-6.

German PS, Shapiro S, Skinner EA, Von Korff M, Klein LE, Turner RW, et al. Detection and Management of Mental Health Problems of Older Patients by Primary Care Providers. JAMA. 1987; 257(4):489-493. http://doi.org/fh9m92.

Magruder-Habib K, Zung WW, Feussner JR. Improving physicians' recognition and treatment of depression in general medical care. Results from a randomized clinical trial. Med Care. 1990; 28(3):239-250. http://doi.org/c9ntqz.

Christensen KS, Toft T, Frostholm L, Ørnbol E, Fink P, Olesen F. The FIP study: a randomised, controlled trial of screening and recognition of psychiatric disorders. Br J Gen Pract. 2003; 53(495):758-63.

Aragones E, Pinol J, Labad A. The overdiagnosis of depression in non-depressed patients in primary care. Fam Pract. 2006; 23(3):363-368. http://doi.org/cpcdxg.

MaGPIe Research Group. The effectiveness of case-finding for mental health problems in primary care. Br J Gen Pract. 2005; 55(518):665-9.

Kendrick T, Stevens L, Bryant A, Goddard J, Stevens A, Raftery J, et al. Hampshire depression project: changes in the process of care and cost consequence. Br J Gen Pract. 2001; 51(472):911-3.

Thompson C1, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, et al. Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet. 2000; 355(9199):185-191. http://doi.org/d9dj3m.

Gómez C, Bohórquez A, Okuda M, Gil JF, Tamayo N, Rey D. Exactitud en el diagnóstico de depresión por médicos de atención primaria después de una intervención educativa. Rev Colomb Psiquiatr. 2007; 36(3):439-50.

Tiemens BG, Ormel J, Jenner JA, van der Meer K, Van Os TW, van den Brink RH, et al. Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes? Psychol Med. 1999; 29(4):833-845. http://doi.org/dg2k8v.

Zung WW, King RE. Identification and treatment of masked depression in a general medical practice. J Clin Psychiatry. 1983; 44(10):365-8.

Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM. Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatri Soc. 1994; 42(8):839-846. http://doi.org/5kn.

Callahan CM, Dittus RS, Tierney WM. Primary care physicians' medical decision making for late-life depression. J Gen Intern Med. 1996; 11(4):218-225. http://doi.org/ddj9tr.

Katzelnick DJ, Simon GE, Pearson SD, Manning WG, Helstad CP, Henk HJ, et al. Randomized trial of a depression management program in high utilizers of medical care. Arch Fam Med. 2000; 9(4):345-51. http://doi.org/d9sv9t.

Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unützer J, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000; 283(2):212-220. http://doi.org/c7thrd.

Rost K, Nutting P, Smith J, Werner J, Duan N. Improving depression outcomes in community primary care practice: a randomized trial of the QuEST intervention. Quality Enhancement by Strategic Teaming. J Gen Intern Med. 2001; 16(3):143-149. http://doi.org/bmmhfz.

Jarjoura D, Polen A, Baum E, Kropp D, Hetrick S, Rutecki G. Effectiveness of Screening and Treatment for Depression in Ambulatory Indigent Patients. J Gen Intern Med. 2004; 19(1):78-84. http://doi.org/d9vprm.

Rubenstein LZ, Alessi CA, Josephson KR, Trinidad Hoyl M, Harker JO, Pietruszka FM. A randomized trial of a screening, case finding, and referral system for older veterans in primary care. J Am Geriatr Soc. 2007; 55(2):166-174. http://doi.org/dx883n.

Whooley MA, Stone B, Soghikian K. Randomized trial of case-finding for depression in elderly primary care patients. J Gen Intern Med. 2000; 15(5):293-300. http://doi.org/d7gfwk.

Bosmans J, de Bruijne M, van Hout H, van Marwijk H, Beekman A, Bouter L, et al. Cost-effectiveness of a disease management program for major depression in elderly primary care patients. J Gen Intern Med. 2006; 21(10):1020-1026. http://doi.org/ch5zfc.

Valenstein M, Vijan S, Zeber JE, Boehm K, Buttar A. The cost-utility of screening for depression in primary care. Ann Intern Med. 2001; 134(5):345-60. http://doi.org/5kp.

Goldberg D, Privett M, Ustun B, Simon G, Linden M. The effects of detection and treatment on the outcome of major depression in primary care: a naturalistic study in 15 cities. Br J Gen Pract. 1998; 48(437):1840-1844.

Goldberg DP, Jenkins L, Millar T, Faragher EB. The ability of trainee general practitioners to identify psychological distress among their patients. Psychol Med. 1993; 23(1):185-193. http://doi.org/fm53gc.

Gask L, Rogers A, Oliver D, May C, Roland M. Qualitative study of patients' perceptions of the quality of care for depression in general practice. Br J Gen Pract. 2003; 53(489):278-283.

Bushnell J, McLeod D, Dowell A, Salmond C, Ramage S, Collings S, et al.Do patients want to disclose psychological problems to GPs? Fam Pract. 2005; 22(2):631-637. http://doi.org/dt3xrp.

Pilgrim D, Dowrick C. From a diagnostic-therapeutic to a social existential response to "depression". J Public Ment Health. 2006; 5(2):6-12. http://doi.org/dr5xq7.

Burroughs H, Lovell K, Morley M, Baldwin R, Burns A, Chew-Graham C. "Justifiable depression": How primary care professionals and patients view late-life depression? A qualitative study. Fam Pract. 2006; 23(3):369-377. http://doi.org/d7s7nj.

May C, Allison G, Chapple A, Chew-Graham C, Dixon C, Gask L, et al. Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts. Sociol Health Illn. 2004;26(2):135-158. http://doi.org/b9m2fv.

Popay J, Kowarzik U, Mallinson S, Mackian S, Barker J. Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective. J Epidemiol Community Health. 2007; 61(11):966-971. http://doi.org/dwfdvt.

Ellis CG. Chronic unhappiness. Investigating the phenomenon in family practice. Can Fam Physician. 1996; 42: 645-651.

Pilgrim D, Bentall R. The medicalisation of misery: A critical realist analysis of the concept of depression. J Ment Heal. 1999; 8(3):261-274. http://doi.org/c89jck.

National Institute for Health and Clinical Excellence. Depression in adults with a chronic physical health problem: treatment and management. London: NICE, 2009.

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