Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

Abstract

BackgroundThis study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong.MethodsA cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management.Results10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor.ConclusionAbout one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.

Help-seeking intentions and subsequent 12-month mental health service use in Chinese primary care patients with depressive symptoms

“…It was conducted as part of a larger epidemiological study to examine the naturalistic outcomes of depressive disorders in Hong Kong's primary care. 12 15 …”

“… 7 11 Aside from personal attitudinal and sociocultural barriers, there are also many practical barriers to receiving help for mental health. Detection rates for depression are relatively low in primary care 12 13 and access to psychosocial services is difficult due to the user-pay system in the private sector, 14 and long waiting times in the public sector. 11 10…”

12-Month naturalistic outcomes of depressive disorders in Hong Kong's primary care

“…Longitudinal data collection occurred between October 2010 and January 2013. The study protocol and preliminary findings of the cross-sectional study have been previously published ( 2 , 6 ). This paper focusses on the findings of the cohort study.…”

“…Depression has been identified as a global public health issue including in Hong Kong ( 1 ). A recent study conducted in Hong Kong’s primary care setting estimated the cross-sectional prevalence for moderate to severe depression [defined as Patient Health Questionnaire-9 (PHQ-9) score >9] as 10.9%, however of these, only 23.1% were diagnosed as having depression by the doctor ( 2 ).…”

The factors affecting mental health status of people attending family health centers

“…[7] Yapılan çalışmalarda, genç, bekâr, işsiz olmak, egzersiz yapmamak, gelir düzeyinin düşük olması, komorbidite, ailesinde ruhsal sorun olma, öyküde ruhsal sorun olma gibi faktörlerin ruh sağlığının olumsuz etkilenmesi için risk faktörlerinden olduğu görülmüştür. [8] Avrupa ülkelerinde, kadınların erkeklere göre ruh sağlığı hizmetlerinden daha fazla yararlandıkları tespit edilmiştir. [9] Sağlık sistemi içerisinde yer alan birinci basamak sağlık hizmetleri, hastaların ilk başvuru yeri olup, kapsayıcı, sürekli ve eş güdüm içerisinde bireylere koruyucu ve tedavi edici hizmetleri bir arada sunması gerekmektedir.…”