Charakteristika und Verlaufsbeschreibung von Patienten in der Integrierten Versorgung Depression Aachen

Abstract The diagnosis of depression increases in our society. The resulting rise of its direct and indirect costs points towards a higher medical and socioeconomic relevance.The current treatment of depressive patients reveals substantial deficits. These concern mainly the low recognition rate of depression in primary care and the guideline adapted therapy. The “Integrated Care Depression Aachen” tried to remedy these deficits by using standardized diagnostics and documentation as well as with superior guidelines. The basic idea was to facilitate the interface and to ensure a standardized high-quality care and thus reduce the financial burden for society. The aim of this dissertation was the description of the nationwide first integrated care of depression and the characterization of its clientele (n=578). We demonstrated the various parameters in 90-days-intervals, and indicated the severity of depression. Besides we investigated the well-being and the general health status at the beginning of the treatment and after one year. With an identical sub-sample we wanted to present the development of the Hamilton rating scale of depression, the well-being and the general health status after one year. All parameters showed a significant improvement and proved the efficiency of the treatment. To investigate potential influencing factors we took the Hamilton score as a valid and continuous parameter as the target variable. As significant influencing factors we detected the psychosocial strain, the CGI, the ICD-10-Code, the mental comorbidity and the specification of the doctor. The findings of this work were aimed at an increased awareness of general practitioners as well as a development of the recognition and therapy of depression in primary care. Besides an area-wide interdisciplinary network of different structures should ensure a high-quality care in accordance with the guidelines. The overriding aim is to combine measures to influence the development of depression and comorbidity in a positive way. Thus the quality of life of the patients should increase while the direct and indirect costs should decrease accordingly