Abstract
Objetivo
Estudiar la prevalencia de depresión en atención primaria (AP) y la detección de los trastornos depresivos por el médico de AP, así como los factores que influyen en ella.
Diseño
Estudio transversal, descriptivo.
Emplazamiento
Centro de Asistencia Primaria Gavà II (Barcelona).
Participantes
Se seleccionaron de manera aleatoria 400 personas de 18–65 años que acudieron según cita previa a consulta con su médico de AP.
Mediciones principales
Se administró un cuestionario sociodemográfico, el test de cribado de depresión de Beck (BDI) y se revisaron los datos clínicos de su historia. Además a una submuestra de 40 personas se les pasó la entrevista diagnóstica MINI. Se estimó el punto de corte óptimo para el BDI respecto la MINI.
Resultados
Se seleccionó el punto de corte 20/21 de depresión del BDI, con sensibilidad del 86,7% y especificidad del 92%, utilizando como referencia el resultado de la entrevista MINI. La prevalencia corregida del trastorno depresivo en AP es de un 20,2%; un 8,1% en varones y el 26,8% en mujeres (odds ratio [OR] = 4,15; p < 0,01). El médico detecta sintomatología depresiva en un 55,7% de los probables casos de depresión. Las personas con BDI 3 21 visitan más a su médico de AP y han presentado más acontecimientos vitales estresantes que las que puntúan BDI £ 20.
Conclusiones
Existe una elevada prevalencia de depresión en AP. Permanece infradiagnosticado un 44,3% de las personas con probable trastorno depresivo (sobre todo mujeres, viudos, jubilados, los que han presentado acontecimientos vitales estresantes y los individuos más frecuentadores).
Palabras clave: Atención primaria, Trastornos depresivos, Prevalencia, Acontecimientos vitales
Abstract
Aim
To study the prevalence of depression in primary care, the detection of depressive disorders by primary care physicians, and the factors that influence detection.
Design
Cross-sectional, descriptive study.
Setting
Gavà II Primary Care Center, in Barcelona, Spain.
Participants
A total of 400 people between the ages of 18 and 65 years were chosen randomly from among those who attended appointments with their primary care physician.
Main measures
A sociodemographic questionnaire and the Beck Depression Inventory (BDI) screening test were administered, and the participant´s medical record was reviewed. In a subsample of 40 participants, the Mini-International Neuropsychiatric Interview (MINI) was also administered. The optimum cutoff score for the BDI was estimated with reference to the MINI results.
Results
A cutoff score of 20/21 for the BDI had a sensitivity of 86.7% and a specificity of 92%, when the MINI score was used as a reference. The adjusted prevalence of depressive disorder in our primary care setting was 20.2% overall, 8.1% in men, and 26.8% in women (odds ratio 4.15, p < 0.01). The physician detected depressive symptoms in 55.7% of all likely cases of depression. Persons who scored 3 21 on the BDI made more visits to their primary care physician, and had more stressful life events, than those who scored £ 20.
Conclusions
The prevalence of depression in our primary care setting is high. The disorder was underdiagnosed in as many as 44.3% of the persons likely to have depressive disorder (especially women, widows and widowers, retired persons, persons who had experienced stressful life events, and frequent users of primary care services).
Key words: Primary care, Depressive disorder, Prevalence, Life events
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