Data from the World Health Organization (WHO) Collaborative Study on Psychological Problems in General Health Care, which was conducted in 26,422 primary care attendees in 14 countries worldwide, and from the Institut National de la Santé et de la Recherche Médicale (INSERM) study, which was conducted in over 2400 consecutive primary care patients in France, demonstrate the high prevalence of major depression in general practice (13.7% and 14.0% in each study, respectively). These 2 studies are supported by the more recent European Study of the Epidemiology of Mental Disorders (ESEMeD), which was conducted in over 21,400 adults from the general populations of 6 European countries and which revealed a lifetime prevalence rate for major depression of 13.4%. Despite this high prevalence, both the WHO and INSERM studies revealed that only 54% to 58% of depressed patients were recognized as "psychiatric cases" by their general practitioner and only 15% to 26% were given a specific diagnosis of depression. Even when cases were recognized, treatment was frequently inappropriate. In the WHO study, only 43% of patients correctly diagnosed with depression by their general practitioner were prescribed an antidepressant, and only 31% of patients recognized as "anxious" received an anxiolytic agent (14% were prescribed an antidepressant). In the ESEMeD study, only 4.6% of adults diagnosed with depression were using antidepressants exclusively, and 18.4% had used anxiolytic medications exclusively. The willingness to prescribe antidepressants and anxiolytic agents is influenced, in part, by diagnosis, patient age and gender, comorbidity (and severity), and the number of spontaneous psychological complaints.
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