Evaluation of ICD-10 PHC mental health guidelines in detecting and managing depression within primary care

The prevalence of mental disorders in the community is high, yet many remain unrecognised, misdiagnosed or poorly managed within primary care. Hence, guidelines for diagnosing and managing mental disorders in primary care, ICD-10 PHC, have been developed.

To introduce the guidelines into primary care and to assess whether they improve recognition, accuracy of diagnosis and treatment standards.

GPs recorded information on all patients presenting with mental disorders before and after guidelines were introduced. A 10% sample of patients underwent interviews to establish a formal diagnosis. Recognition of mental disorders was assessed by screening of patients attending their GP.

The guidelines had no impact on the overall detection of mental disorders, the accuracy of diagnosis or the prescription of antidepressants. There was a significant increase in the number of patients diagnosed with depression or unexplained somatic symptoms. The GPs also made increased use of psychological interventions.

The success of the guidelines in bringing about change is by no means certain. Some areas appeared more susceptible to change than others.