Detección del trastorno depresivo mayor en atención primaria. Una revisión

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.