Editorials

Improving outcomes in depression

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7319.948 (Published 27 October 2001) Cite this as: BMJ 2001;323:948

The whole process of care needs to be enhanced

  1. Michael Von Korff, senior investigator (Vonkorff.m@ghc.org),
  2. David Goldberg, professor emeritus (d.goldberg@iop.kcl.ac.uk)
  1. Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA
  2. Institute of Psychiatry, King's College, London SE5 8AF

    Around 450 million people worldwide have mental or psychosocial problems, but most of those who turn to health services for help will not be correctly diagnosed or will not get the right treatment.1 Even those whose problems are recognised may not receive adequate care. In a World Health Organization study of psychological disorders in general health care carried out in 14 countries around the world patients with major depression were as likely to be treated with sedatives as with antidepressants, although antidepressants were associated with more favourable outcomes at three month follow up. This benefit had dissipated by follow up at 12 months; but patients had only been taking drug treatment for a mean of 11 weeks, with a quarter of them doing so for less than a month.2 About two thirds of patients whose illnesses were recognised and treated with drugs still had a diagnosis of mental illness at follow up one year later, and in nearly a half the diagnosis was still major depression. Indeed, there are …

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