A randomized controlled trial to improve the recognition, diagnosis and treatment of major depression in elderly people in general practice: Design, first results and feasibility of the West Friesland Study

Depression is a common and important disorder in later life. Yet there are concerns about the recognition and treatment of patients with major depressive disorder in general practice. Interventions incorporated in disease management programmes that are aimed at improving screening, diagnosis and treatment might be of benefit to the outcomes for elderly patients. A randomized, controlled trial that compared the effects of an intervention programme aiming to improve the recognition, diagnosis and treatment of depression in elderly patients with care as usual was performed in The Netherlands. The 15-item version of the Geriatric Depression Scale (GDS-15) was used for screening and the mood module of the PRIMary care Evaluation of Mental Disorders (PRIME-MD) was used for diagnosis. In total 43 general practitioners (GPs) from 34 practices were willing to participate. Eighteen practices (23 GPs) were allocated to the intervention group and 16 practices (20 GPs) were allocated to the care as usual group. The GPs in the intervention group were trained in consecutive training sessions that were repeated once. Practice assistants in both groups were trained in carrying out the screening. Some 4000 patients over 55 years of age were screened in the practices from June 2000 to October 2002. A total of 579 patients had a positive score on the GDS-15 and, of these, 178 had a diagnosis of depression on the PRIME-MD. Informed consent for participating in the trial was obtained from 145 patients. It was concluded that it is feasible to screen large numbers of elderly patients for the existence of depression in general practice for recruitment into a randomized trial, although there were difficulties in achieving this.