Gaps in Depression Care: Why Primary Care Physicians Should Hone Their Depression Screening, Diagnosis, and Management Skills

Abstract

Objective: To highlight the potential role that occupational and environmental physicians can play in providing high quality depression care by describing: the profound impact that depression can have on development and persistence of unexplained medical symptoms such as pain; the impact of depression on social and occupational functioning; the adverse effect of comorbid depression in patients with chronic medical illness on self-care and medical outcomes; and the significant direct and indirect costs associated with depression. Method: Literature review. Results: Despite evidence-based treatment guidelines, suboptimal depression care persists. Conclusions: Building on the tenets of the chronic illness care model as well as the principles of public health, three approaches are required to address the gaps between knowledge and practice: 1) improve accuracy of diagnosis; 2) prevent chronic depres- sion; and 3) prevent relapse and recurrence. (J Occup Environ Med. 2008;50:451-458) S