چکیده (انگلیسی):

Background:Depression is a common mental disorder with a high burden of disease which is mainly treated in
primary care. It is unclear to what extent stepped care principles are applied in routine primary care. The first aim of
this explorative study was to examine the gap between routine primary depression care and optimal care, as
formulated in the depression guidelines. The second aim was to explore the facilitators and barriers that affect the
provision of optimal care.
Methods:Optimal care was operationalised by indicators covering the entire continuum of depression care: from
prevention to chronic depression. Routine care was investigated by interviewing general practitioners (GPs)
individually and together with other mental health care providers about the depression care they delivered
collaboratively. Qualitative analysis of transcripts was performed using thematic coding. Additionally, the GPs
completed a self-report questionnaire.
Results:Six GPs and 22 other (mostly primary) mental health care providers participated. The GPs and their primary
care colleagues embraced a general stepped care approach. They offered psycho-education and counselling to
mildly depressed patients. When the treatment effects were not satisfactory or patients were more severely
depressed, the GPs offered, or referred to, psychotherapy or pharmacotherapy. Patients with a complex and severe
depressive disorder were directly referred to specialised mental health care. However, GPs relied on their clinical
judgment and rarely used instruments to assess and monitor the severity of depressive symptoms. Structured,
evidence based interventions such as self-management and e-health were rarely offered to patients with depressive
symptoms. Specific psychological interventions for relapse prevention or for chronically depressed patients were not
available. A wide range of influencing factors for the provision of optimal depression care were put forward. Close
collaboration with other mental health care professionals was considered an important factor for improvement by
nearly all GPs.
Conclusions:The management of depression in primary care seems in line with stepped care principles, although it
can be improved by applying more elements of a stepped care approach. Collaboration between GPs and mental
health care providers in primary care and secondary care should be enhanced.