Mental illnesses represent a cost equivalent to 3-4% of European GDP due, to a large extent, to productivity losses, early retirements, and the perception of disability pensions of the people affected. Most studies place the prevalence of depressive disorders between 9 and 20% of the world population. In Spain, depression is the most frequent mental disorder, with a prevalence of between 5 and 10%, that is, between two and four million people, although experts estimate that there could be up to six million affected by this pathology. , half of which would not be diagnosed. In addition, one in five people who go to primary care (PC) consultation suffer from depression.
According to World Health Organization (WHO), currently the depression is the first world cause of disability, and the origin of 27% of all years of disability generated by all conditions. "Among the intangible costs are those related to the way society treats people suffering from these disorders: people who continue to suffer exclusion, stigmatization, discrimination or lack of respect for their fundamental rights. Also, we must consider the overload of caregivers and relatives of the people affected, "explained Dr. José Ángel Arbesú, coordinator of the Mental Health Group of SEMERGEN as part of the seventh edition of the Meetings for Psychiatry and Primary Care, held in Madrid on the 13th and 14th. of May.
In this meeting, organized by the Spanish Society of Primary Care Physicians (SEMERGEN) and the Spanish Society of Psychiatry (SEP) topics of great interest for the clinical practice of the PC doctor were addressed as an update of the pharmacological treatments for depression; the psychopharmacological therapeutic guidelines possible to follow in patients who do not respond adequately to treatment; the association of depression to chronic pain that requires a specific focus on therapeutics; the care for patients with Alzheimer's disease, whose complexity and importance affects not only the patient but also the habitual caregiver; mood disorders at the end of life, which imply in a special way the PC doctor; and the urgent attention to mental illness.
The role of PA in the care of patients with depression
Affective disorders are among the most prevalent mental illnesses and, therefore, among those that generate the greatest number of consultations in PA. Some epidemiological data show the importance of affective disorders, and especially of depression, since one in five people will suffer a depressive episode throughout their lives, and about 14.4% of patients with severe depression try to commit suicide . In addition, 6.5% of the population refers to suffering chronic depression, of which 3.7% are men and 9.2% are women. Depression increases with age, exceeding 6% of men and 14.5% of women over 65 years.
"The family doctor is the key to reach an early detection, both of depression and anxiety, two pathologies that often appear together"
According to him First White Paper of the Depression, the profile of the patient with depression in Primary Care would be as follows: woman; mean age of 53 years; average frequency of attendance at the consultation: 5 weeks; high level of compliance with established appointments; go to the AP office before the psychiatrist; It is not the first time your doctor sees you; Half of the cases are diagnosed as reactive depressions; the diagnosis most associated with depression is GAD; of every 10 patients who have been diagnosed with depression in the last year, four had had previous episodes; predominant symptoms: sadness (78%), apathy (61%), insomnia (60%); anxiety accompanies depression in 18% of cases; predominant trigger factor: social or affective situation (11%); half of the patients present some additional pathology: arthritis / arthrosis (37%), dyslipidemia (33%), diabetes (21%), osteoporosis (11%).
In more than 80% of cases, the treatment and follow-up of patients with mental disorders is assumed by the PC physician. Only between 10 and 15% of patients arrive at psychiatric consultations."That means that family doctors detect and resolve between the remaining 85 and 90%, and assume the treatment of patients and their control," says Dr. Arbesú.
According to Dr. Martín, "the patient is referred to the psychiatric clinic when there is a lack of response to treatment, his situation becomes chronic, it is a psychotic or melancholic depression, an attempt of suicide occurs, the depressive episode is part of a bipolar disorder, when there are social circumstances of high risk or, finally, by express request of the patient ".
For all these reasons, "the family doctor is the key to reach an early detection, both of depression and anxiety, two pathologies that often appear together: the most frequent mental health problems in Primary Care are the depression (68%), followed by anxiety (12%), mixed anxious-depressive disorders (9.5%), dysthymia or other affective disorders (2%) and associated personality disorders, for example, to the abuse of toxic substances (0.5%) ", concludes Dr. Arbesú.
Sources: Spanish Society of Primary Care Physicians (SEMERGEN) and Spanish Society of Psychiatry (SEP)