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

• Published in: BMC family practice 2014-02, Vol.15 (1), p.30-30, Article 30
• Main Authors: Chin, Weng Yee, Chan, Kit T Y, Lam, Cindy L K, Wong, Samuel Y S, Fong, Daniel Y T, Lo, Yvonne Y C, Lam, Tai Pong, Chiu, Billy C F
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antidepressants; Biomedical Research; Care and treatment; Complications and side effects; Cross-Sectional Studies; Depression - diagnosis; Depression - therapy; Depression, Mental; Diagnosis; Female; Hong Kong; Hospitals; Humans; Male; Mental depression; Mental disorders; Middle Aged; Patient outcomes; Physicians; Prevalence; Primary care; Primary Health Care; Surveys and Questionnaires; Young Adult
• ISSN: 1471-2296; 1471-2296
• DOI: 10.1186/1471-2296-15-30

This study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong. A 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. 10,179 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. About 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.