DÄ internationalArchive8/2018Limitations of the Study
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In our opinion, the study (1) has substantial limitations/shortcomings—but these were not mentioned in the text. This makes it almost impossible to interpret the results.

  • The data came from only 5.8% of the physicians who had been contacted—consequently they are anything but representative.
  • The Depression Screening Questionnaire (DSQ) was developed for the purpose of screening; it cannot be used to make a clinical diagnosis. This means that a substantial proportion of patients whose test results were positive do not actually have depression—as is made clear by the low specificity of the test (2). Furthermore, the test reflects only what happens in those few weeks that the questions relate to. This makes it impossible to make a diagnosis of depression, as in some cases it is only situation-specific low mood that is being measured (3).
  • Defining a mean value that includes patients with suspected mild to moderate depression, is misleading, especially as far as assessing the quality of treatment is concerned. Medication treatment for mild, even moderate, depression is explicitly stated to be not sufficiently evidence-based in the current version of the national disease management guideline (4), which also applied at the time when the study was conducted. The same is true for international guidelines.

Apart from the—flawed—study, it deserves to be said that the treatment of the depressive patients (who had been identified by the GPs themselves, without using any questionnaire) seemed very good indeed. Therapy rates in severe, moderate, and mild depression were 97%, 87.5%, and 79.1%. To infer inadequate treatment from such results and to deduce from that the need to “improve general practitioners’ ability to diagnose these conditions and determine the indication for treatment” is unsupportable. Rather, it shows the authors’ biases.

DOI: 10.3238/arztebl.2018.0133a

Prof. Dr. med. Heinz-Harald Abholz (Emeritus)
Institut für Allgemeinmedizin, Universität Düsseldorf

Dr. med. Günther Egidi
Abteilung Allgemeinmedizin, Universität Göttingen

Prof. Dr. med. Michael M. Kochen, MPH, FRCGP (Emeritus)
Abteilung Allgemeinmedizin, Universität Göttingen
Lehrbereich Allgemeinmedizin, Universität Freiburg

Dr. med. Uwe Popert
Abteilung Allgemeinmedizin, Universität Göttingen
uwe.popert@web.de

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
Trautmann S, Beesdo-Baum K, Knappe S, et al.: The treatment of depression in primary care—a cross-sectional epidemiological study. Dtsch Arztebl Int 2017; 114: 721–8 VOLLTEXT
2.
Becker N, Abholz H-H: Prävalenz und Erkennen von depressiven Störungen in deutschen Allgemeinarztpraxen – eine systematische Literaturübersicht. Zeitschr Allg Med 2005; 81: 474–81 CrossRef
3.
Sielk M, Altiner A, Janssen B,et al.: Prävalenz und Diagnostik depressiver Störungen in der Allgemeinpraxis – ein kritischer Vergleich zwischen PHQ-D und hausärztlicher Einschätzung. Psychiat Praxis 2009; 36:169–74 CrossRef MEDLINE
4.
DGPPN, BÄK, KBV, AWMF (eds.) für die Leitliniengruppe Unipolare Depression: S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung, 2. Edition. Version 5. 2015. www.depression.versorgungsleitlinien.de (last accessed on 30 January 2018).
1.Trautmann S, Beesdo-Baum K, Knappe S, et al.: The treatment of depression in primary care—a cross-sectional epidemiological study. Dtsch Arztebl Int 2017; 114: 721–8 VOLLTEXT
2.Becker N, Abholz H-H: Prävalenz und Erkennen von depressiven Störungen in deutschen Allgemeinarztpraxen – eine systematische Literaturübersicht. Zeitschr Allg Med 2005; 81: 474–81 CrossRef
3.Sielk M, Altiner A, Janssen B,et al.: Prävalenz und Diagnostik depressiver Störungen in der Allgemeinpraxis – ein kritischer Vergleich zwischen PHQ-D und hausärztlicher Einschätzung. Psychiat Praxis 2009; 36:169–74 CrossRef MEDLINE
4.DGPPN, BÄK, KBV, AWMF (eds.) für die Leitliniengruppe Unipolare Depression: S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung, 2. Edition. Version 5. 2015. www.depression.versorgungsleitlinien.de (last accessed on 30 January 2018).

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