TY - JOUR T1 - Reasons to be cheerful? Reflections on GPs' responses to depression JF - British Journal of General Practice JO - Br J Gen Pract SP - 636 LP - 637 DO - 10.3399/bjgp09X454025 VL - 59 IS - 566 AU - Christopher Dowrick Y1 - 2009/09/01 UR - http://bjgp.org/content/59/566/636.abstract N2 - The papers related to depression in this issue of the Journal offer reasons to be cheerful about GPs' diagnostic abilities and treatment decisions: but they also generate internal debate, and require further reflection.The perennial question of whether GPs are competent at diagnosing depression receives an affirmative response from the study in the Grampian region of Scotland undertaken by Cameron et al.1 This study confirms previous research from Hampshire and elsewhere that GPs are more likely to make a diagnosis of depression as symptom severity increases.2 The assessment of depression in primary care is increasingly supported by the use of patient self-completion severity rating instruments, but care is needed in how to interpret them. The Swedish study by Hansson et al3 corroborates earlier analyses identifying diagnostic discrepancies between the Hospital Anxiety and Depression Scale and the Patient Health Questionnaire (PHQ-9),4 and shows that the currently recommended threshold score of 10 on the latter is more likely to lead clinicians to diagnose major depression. They support recent research in England, which calls for an increase in PHQ-9 threshold score from 10 to 12 for major depression in order to reduce the risk of over-diagnosis.5We may therefore assume from these studies that GPs' diagnostic abilities are already in reasonable shape, and could be improved by judicious use of severity rating instruments. However there are important caveats to such an assumption. A focus on symptom counts, which has been encouraged in the UK by the introduction of performance targets for GPs linked to the measurement of depression severity at initiation of treatment,6 may well be necessary: but it is far … ER -