Case-finding and risk-group screening for depression in primary care

Figures & data

Table I. Prevalence of depression in risk groups (no clinical suspicion) and case finding (clinical suspicion) groups according to GP ICD-10 based diagnostic assessment.

Risk group*	Risk-group
	Total Depressed		Screening Depressed		Case-finding Depressed
	n	(%)	n	(%)	n	(%)	RR	95% CI	p-value
Previous depression	213	103 (48.4)	64	6 (9.4)	149	97 (65.1)	6.94	(2.86–16.86)	<0.001
Familial predisposition for depression	89	53 (59.6)	26	8 (30.8)	63	45 (71.4)	2.32	(1.26–4.29)	0.007
Heart disease	105	17 (16.2)	76	3 (4.0)	29	14 (48.3)	12.23	(3.04–49.12)	<0.001
Stroke	18	6 (33.3)	11	1 (9.1)	7	5 (71.4)	7.86	(1.05–58.91)	0.045
Chronic pain condition	127	53 (41.7)	52	8 (15.4)	75	45 (60.0)	3.90	(2.25–6.77)	<0.001
Diabetes	75	14 (18.7)	52	3 (5.8)	23	11 (47.8)	8.29	(2.53–27.17)	<0.001
Chronic obstructive lung disease	34	9 (26.5)	19	1 (5.3)	15	8 (53.3)	10.13	(1.63–63.15)	0.013
Cancer	33	8 (24.2)	19	1 (5.3)	14	7 (50.0)	9.50	(1.72–52.56)	0.010
Parkinson's disease	4	0 (0.0)	2	0 (0.0)	2	0 (0.0)	1.00	(0.10–9.61)	1.000
Epilepsy	4	2 (50.0)	2	0 (0.0)	2	2 (100)	NA	NA	NA
Other mental disorders	91	47 (51.7)	42	13 (31.0)	49	34 (69.4)	2.24	(1.62–3.11)	<0.001
Pregnancy or postpartum	22	1 (4.6)	18	0 (0.0)	4	1 (25.0)	NA	NA	NA
Refugee/immigrant	34	17 (50.0)	16	3 (18.8)	18	14 (77.8)	4.15	(1.37–12.57)	0.012
Total	672	238 (35.4)	330	31 (9.4)	342	207 (60.5)	6.44	(3.54–11.71)	<0.001

Note:*Patients may belong to one or more risk groups: no risk group 11.7%, one risk group 60.3%, two or more risk groups 28.0%.

Table II. General practitioner diagnosis of depression according to risk-group or case-finding strategies.

Diagnosis	Total (%)	Risk group (%)	Case finding (%)	p-value*
No depression	434 (64.6)	299 (90.6)	135 (39.5)
Mild depression	67 (10.0)	14 (4.3)	53 (15.5)
Moderate depression	100 (14.9)	11 (3.3)	89 (26.0)	<0.001
Severe depression	71 (10.5)	6 (1.8)	65 (19.0)
Total	672 (100)	330 (100)	342 (100)

Note: *Test for trend in proportion.

Table III. Effectiveness of case-finding strategy for diagnosing depression according to GP ICD-10 based diagnostic assessment.

	Depressed	Not depressed	Total (%)
GP suspicion	207	135	342 (51)
No GP suspicion	31	299	330 (49)
Total (%)	238 (35)	434 (65)	672 (100)

Notes: SE = 207/238 = 0.87; SP = 299/434 = 0.69; TPR = 207/342 = 0.61; FPR = 135/342 = 0.39; TNR = 299/330 = 0.91; FNR = 31/330 = 0.09.

Table IV. Association between ICD-10 based depression diagnosis and model variables (238 cases were included in the analyses).

Risk group	Prevalence ratio (95% CI)	p-value
Previous depression	0.39 (0.18–0.85)	0.018
Familial predisposition to depression	1.31 (0.68–2.51)	0.421
Heart disease	2.54 (0.56–11.45)	0.226
Stroke	2.18 (0.40–11.99)	0.369
Chronic pain condition	1.49 (0.72–3.05)	0.281
Diabetes	2.57 (0.73–9.05)	0.140
Chronic obstructive lung disease	0.80 (0.10–6.45)	0.835
Cancer	2.10 (0.23–18.88)	0.506
Parkinson's disease	NA	NA
Epilepsy	<0.001	<0.001
Other mental disorders	3.15 (1.91–5.20)	<0.001
Pregnancy or postpartum	<0.001	<0.001
Refugee/immigrant	1.33 (0.54–3.25)	0.533
Sex	1.64 (0.76–3.55)	0.211
Age	0.98 (0.96–1.00)	0.105