Recommendations Seem Arbitrary

The authors deserve thanks for their recent evaluation of routine data on the state of care for people with a diagnosis of depression (1). To summarize, the healthcare situation is described as “overall insufficient,” because, for example, “only 10% of patients with severe depression receive services that are subject to an application process in line with the psychotherapy guideline, and only 60% of patients were prescribed antidepressants.” Aptly, the methodological limitation is then mentioned that the authors have not found it possible to determine the causes for this on the basis of routine SHI data. In spite of this, in their concluding sentence they recommend that more intensive training needs to be provided in continuing medical education on important aspects such as correct diagnosis, severity estimation, as well as the initiation of guideline-oriented therapy, especially in the primary care sector (1).

This recommendation seems arbitrary on the background of the named methodological limitations, is not consistent with the presented data, and focuses one-sidedly on doctor-related causes, whose proportion in the insufficient state of care remains unclear.

Intervention studies of the outpatient care for people with depression in Germany from recent years have shown that more intensive training and collaboration do not necessarily translate into improved guideline adherence or quality of care (2). Rather (and at least also) the structural causes of the unsatisfactory care situation—namely, too few outpatient and inpatient psychotherapy places—should be researched and tackled (3).