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Background Multimorbidity is a highly frequent condition in older people, but well designed longitudinal studies on the impact of multimorbidity on patients and the health care system have been remarkably scarce in numbers until today. Little is known about the long term impact of multimorbidity on the patients' life expectancy, functional status and quality of life as well as health care utilization over time. As a consequence, there is little help for GPs in adjusting care for these patients, even though studies suggest that adhering to present clinical practice guidelines in the care of patients with multimorbidity may have adverse effects. Methods/Design The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed. Discussion The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns) with a comparable impact (e.g. on quality of life and/or functional status) will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an instrument for prediction of the deterioration of the illness process and point at possibilities of prevention. The practical consequences of the study results for primary care will be analysed in expert focus groups in order to develop strategies for the inclusion of the aspects of multimorbidity in primary care guidelines.

Background: Individuals with Mild Cognitive Impairment (MCI) are at high risk to develop dementia and are a target group for preventive interventions. Therefore, research aims at diagnosing MCI at an early stage with short, simple and easily administrable screening tests. Due to the fact that the Cl[for full text, please go to the a.m. URL], 10. Deutscher Kongress für Versorgungsforschung; 18. GAA-Jahrestagung

Norms for change in Mini Mental State Examination (MMSE) total score suggest that only a decline of at least 2-4 points indicates a reliable change. However, it is unknown whether change norms (Reliable Change Indices, RCIs) of the MMSE total score are suitable to predict future dementia.554 elderly individuals aged 75 and over without dementia at the first 2 visits were tested with the MMSE at a maximum of 6 visits with 1.5-year intervals. Two different RCIs for change in MMSE score (first to second visit) were computed - one RCI which corrects for practice and one RCI which corrects for regression to the mean. The main outcome measure was the diagnosis of dementia.During the study, 88 persons developed dementia. RCIs were significantly associated with future dementia diagnosis. The best cutoff for raw change in MMSE total score to predict dementia was -1 point (sensitivity = 48%, specificity = 67%, relative risk = 1.6). With the RCI + regression to the mean, the diagnostic accuracy was moderate (sensitivity = 61%, specificity = 72%, relative risk = 3.2).A change in MMSE total score is significantly associated with future dementia, but the diagnostic accuracy for dementia prediction is rather low.

In the past decades, a substantial number of studies considered factors influencing institutionalisation of persons with dementia. This study reviews recent work on predictors of actual institutionalisation in dementia.Relevant articles were identified by a systematic search of the literature. Studies were considered which included persons aged 65 and over, and whose results were based on prospective design and on multivariate statistical analyses.Forty-two studies were identified. The rate of institutionalisation increased from 20% in the first year after diagnosis to 50% after 5 years. Median time to institutionalisation was estimated between 30 and 40 months. Predictors of institutionalisation were classified according to a provided conceptual framework in the categories sociodemographic and relationship characteristics of persons with dementia and caregivers, primary stressors, secondary stressors and resources.The overview of research activities in this area showed a lack of methodological strength in a large part of identified studies. Nevertheless, a lot of well-examined and less highlighted predictors could be identified.

SUMMARY Background/aims Little is known about the direct costs of individuals with Mild Cognitive Impairment (MCI). This study investigates the direct costs associated with MCI according to recent diagnostic criteria from a societal perspective. Methods Four hundred and fifty-two primary care patients aged 75þ from Leipzig, Germany, were investigated in face-to-face interviews regarding MCI according to the current diagnostic criteria of the International Working Group on MCI,resourceutilisation andcosts(questionnaireof serviceutilisationandcosts),aswellaschronicmedical illness(Chronic Disease Score). Resource utilisation was monetarily valued using 2004/2005 prices. Results Mean annual direct costs were s4,443 for patients with MCI (n ¼39) and s3,814 for patients without MCI (n ¼413) ( p ¼0.34). Looking at the cost components, patients with and without MCI only significantly differed regarding pharmaceutical costs (s 1,210 vs s 1,062; p

Depression among the elderly is an important public health issue. The aims of this study were to report the prevalence of depression and to determine the impact of socio-demographic variables, functional impairment and medical diagnoses, lifestyle factors, and mild cognitive impairment on depression as part of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe Study).Included in the cross-sectional survey were 3327 non-demented subjects aged 75 and over attending general practitioners (GPs) (n=138) in an urban area of Germany. The GDS-15 Geriatric Depression Scale was used to measure depression with a threshold of6/6+. Associations with social and clinical risk factors were assessed by means of multiple logistic regression models.The prevalence of depression was 9.7% (95% confidence interval 8.7-10.7). In a univariate analysis, the following variables were significantly associated with depression: female gender, increasing age, living alone, divorce, lower educational status, functional impairment, comorbid somatic disorder, mild cognitive impairment, smoking, and abstinence from alcohol. After full adjustment for confounding variables, odds ratios for depression were significantly higher only for functional impairment, smoking, and multi-domain mild cognitive impairment.Recruitment procedures might have led to an underestimation of current prevalence. The cross-sectional data did not allow us to analyze the temporal relationship between risk factors and depression.The prevalence of depression in the elderly is high and remains high into old age. In designing prevention programs, it is important to call more attention to the impact of functional and cognitive impairment on depression.

In the current discussion on optimizing psychotherapeutic approaches, two important developments have to be considered: a tendency towards integrative and a tendency towards disorder specific approaches. For the years 2005 and 2006, an analysis of three German journals (covering the fields of psychosomatics, psychiatry and clinical psychology) was conducted on the question whether these two developments can be identified in current empirical and conceptual publications. Contrary to the expectations, there are only very few papers dealing with integrative approaches. As expected, there is a major emphasis on psychodynamic and cognitive behavioural approaches; other approaches are only marginally considered. A disorder specific approach can be identified not only for cognitive behavioural, but also for psychodynamic papers.

In the current discussion on optimizing psychotherapeutic approaches, two important developments have to be considered: a tendency towards integrative and a tendency towards disorder specific approaches. For the years 2005 and 2006, an analysis of three German journals (covering the fields of psychosomatics, psychiatry and clinical psychology) was conducted on the question whether these two developments can be identified in current empirical and conceptual publications. Contrary to the expectations, there are only very few papers dealing with integrative approaches. As expected, there is a major emphasis on psychodynamic and cognitive behavioural approaches; other approaches are only marginally considered. A disorder specific approach can be identified not only for cognitive behavioural, but also for psychodynamic papers.

Depression is a very common disease with substantial economic consequences. This paper reviews all published cost-of-illness studies of depression worldwide.A systematic search of cost-of-illness studies of depression in the databases MEDLINE, Web of Science, Cochrane Library, and PSYNDEXplus was conducted. Identified studies were classified by their basic characteristics. Costs reported were inflated in original currency to the year 2003 and then converted into US-dollar using purchasing power parities (US$ PPP). Additionally, national-costs were converted in costs per case and per inhabitant.24 papers with notable methodical differences were identified and classified by their basic characteristics. Summary estimates from the studies for the average annual costs per case ranged from $1000 to $2500 for direct costs, from $2000 to $3700 for morbidity costs and from $200 to $400 for mortality costs. The basic quantity of interest in COI-studies of depression was stated.Methodical differences limited comparison substantially.Depression is associated with a high economic burden. Conducting COI-studies of depression along the line noted in the review could help provide the opportunity to expose differences in costs associated with different approaches to disease management.

The paper reviews psychiatric epidemiological research in Germany focusing on studies conducted over the last two decades.Relevant studies were identified using Medline and Psyndex databanks.Inspired mainly by Anglo-American research, a substantial body of studies demonstrates the constitution of psychiatric epidemiology as a research field in Germany. The paper reviews field studies in children and adolescents, in adults and the elderly concerning scope, design and methods. Also those studies regarding special populations (i. e. homeless, persons living in nursing homes) usually not covered by field studies were included. Selected results of current surveys were reported to illustrate that mental disorders are common.Future challenges of psychiatric-epidemiological research include (1) the provision of internationally comparable data and (2) the description of individual and contextual risk- and protective factors of mental disorders. The latter can only be achieved by employing longitudinal designs where researcher should adopt a multi-level perspective in questioning and analysis.

Background/Aims Subjects with Mild Cognitive Impairment (MCI) constitute a risk population of developing dementia and thus a population of clinical interest. This study reviews recent work on the incidence of MCI in the elderly. Methods Incidence papers were identified by a systematic literature search. Studies on incidence of MCI were considered if they identified ‘cognitively mild impaired’ subjects by application of the MCI criteria, used the ‘person-years-at-risk’ method, and were based on population-based or community-based samples. Results Nine studies were identified. Incidence of Amnestic MCI subtypes ranged between 9.9 and 40.6 per 1000 person-years, and incidence of Non-amnestic MCI subtypes was found to be 28 and 36.3 per 1000 person-years. Regarding any MCI , incidence rates of 51 and 76.8 per 1000 person-years have been found. A higher risk of incident MCI mainly was found for higher age, lower education and hypertension. Discussion Incidence rates of MCI varied widely, and possible risk factors for incident MCI were analysed only to a limited extent. Findings call for an agreement concerning the criteria used for MCI and the operationalisation of these criteria. Declaration of Interest This review was published with affiliation of the Leipzig Research Center for Civilisation Diseases (LIFE, Universitat Leipzig). LIFE is financed by means of the European Union, by the European Regional Development Fund (ERDF) and by means of the Free State of Saxony within the framework of the excellence initiative.

Background Early detection of dementia has clearly improved. Even though none of the currently available treatments for the most common form of dementia, Alzheimer’s dementia, promises a cure, early diagnosis provides several benefits for patients, caregivers, and health care systems. This study aimed to describe attitudes toward early diagnosis of dementia in the German general population. Methods A representative telephone survey of the German population aged 18+ years (n = 1,002) was conducted in 2011. Results The majority of respondents (69%) would be willing to be examined for early diagnosis of dementia. Almost two thirds reported that they would prefer their general practitioner (GP) as the first source of professional help. More than half of the respondents (55%) stated their belief that dementia could be prevented. Respondents mostly indicated psychosocial prevention options. Conclusions Our findings suggest that the general population in Germany is very open to early diagnosis of dementia; however, this seems connected with large expectations on the effectiveness of prevention options. Dementia awareness campaigns may be employed to carefully inform the public about the prevention options currently available and their efficacy. To exploit GPs’ potential as a gatekeeper for early detection of dementia, their ability to identify patients with antecedent and mild stages of the disease must be improved.

OBJECTIVE: To investigate obesity prevention support in the German general public and to assess determinants of general prevention support as well as support of specific prevention measures. METHODS: This study was a cross-sectional analysis of a telephone based representative German study (3,003 subjects (52.8% women, mean age 51.9, s.d. = 18.0, range 18-97 years). Likert scale-based questions on general prevention support and support of specific measures were used. Furthermore willingness to take part in preventive programs and willingness to pay were assessed. Stigmatizing attitudes were assessed with the Fat Phobia Scale (FPS). Causation of obesity was differentiated in three dimensions (internal, e.g. lack of exercise; external, e.g. social surroundings; and genetic factors). RESULTS: Obesity prevention was perceived as possible (98.2%), however, almost exclusively lifestyle changes were named. Participants with higher stigmatizing attitudes were less likely to believe obesity prevention is possible. The majority of participants would take part in preventive programs (59.6%) and pay at least partially themselves (86.9%). Factor analysis revealed three dimensions of preventive measures: promoting healthy eating, restrictive and financial, governmental prevention efforts. In regard to these, promoting healthy eating was the most supported measure. Higher age, female gender and external causation were associated with higher support for all three dimensions of preventive measures. Only for governmental regulation, higher age was associated with lower support. CONCLUSION: Obesity prevention support in Germany is high. Structural prevention efforts are supported by the majority of the general public in Germany. The vast majority proclaims willingness to pay themselves for programs of weight gain prevention. This could be an indication of higher perceived self-responsibility in the German system but also for risen "fear of fat" in the population due to media coverage. For Germany, the government and communities ought to be encouraged by these results to start the implementation of structural obesity prevention.

Background Recent studies examined the role of psychiatric comorbidity in the process of rehabilitation in patients undergoing herniated disc surgery. These patients suffer from physical and psychosocial complaints or symptoms, which impact their everyday life negatively and the success of rehabilitation potentially. The objectives of this study are (1) to examine the quality of life (QoL) in disc surgery patients and to compare the findings with reference data from the general German population, and (2) to investigate the impact of psychiatric comorbidity on QoL of patients undergoing herniated disc surgery. Methods This study consists of 305 patients aged between 18 and 55 years who took part in face-to-face interviews during their hospital stay. Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). By means of the 36-Item Short-Form Health Survey (SF-36), QoL was assessed in patients undergoing herniated disc surgery with and without psychiatric comorbidity. These findings were compared with the QoL of a representative sample of the general German population. Results Compared with the general population, QoL in patients with herniated disc surgery was lower in all domains of the SF-36. Psychiatric comorbidity impacts the QoL in patients with herniated disc surgery in all SF-36 domains except “physical function”. The patients with psychiatric comorbidity showed significantly lower levels of QoL in the domains “bodily pain”, “vitality”, “social function”, “role emotional”, and “mental health”. Conclusions Psychiatric comorbidity has a substantial adverse effect on QoL in patients undergoing disc surgery. Therefore, it will be necessary to diagnose psychiatric comorbidities at an early stage and to include psychosocial interventions in the treatment of herniated disc patients aimed at improving deficits in psychosocial functioning and QoL.

Objectives Mild Cognitive Impairment (MCI) constitutes a pre-stage of dementia in many cases. The aims of the present study were to estimate age- and gender-specific incidence of MCI and to identify risk factors for incident MCI in a population-based sample of cognitively healthy subjects aged 75 years and older. Methods Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based study of individuals aged 75 years and older. Incidence was calculated according to the ‘person-years-at-risk’ method. Cox proportional hazards models were used to identify risk factors for incident MCI. Results During the 8-year follow-up period, roughly one fourth (n=137; 26.4%) of the population at risk developed MCI. The overall incidence of MCI for subjects aged 75 years and older was 76.5 (95% PCI 64.7 to 90.4) per 1,000 person-years (overall person-years =1791.08). The incidence rate was highest in age group 85+ years and higher in women than men (80.8, 95% PCI 66.6 to 98.0 vs 65.8, 95% PCI 47.0 to 92.1). Cox proportional hazards model identified older age, subjective memory complaints, impairment in instrumental activities of daily living, and lower cognitive performance as significant risk factors for incident MCI. Conclusions MCI has high incidence in the elderly population. The inclusion of restrictions in instrumental activities of daily living in the criteria of MCI particularly might be useful to improve the prediction of dementia. Subjective memory complaints in previously cognitively healthy individuals should be taken seriously as a possible pre-stage of MCI.

Background In previous decades a substantial number of studies examined predictors of nursing home admission (NHA) among elderly individuals with and without dementia. As the first, this study aims to analyse predictors of NHA of incident dementia cases and of individuals without developing dementia before NHA. Methods Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA 75+), a population-based study of individuals aged 75 years and older. Socio-demographic, clinical, and psychometric parameters were requested every 1.5 years over six waves. Kaplan-Meier estimates were used to determine mean time to NHA. Cox proportional hazards regression was used to examine predictors of long-term institutionalisation for both subsamples. Results Of 109 subjects with incident dementia who resided in private home at the time of the dementia diagnosis, 52 had become residents by the end of the study. Being widowed/divorced (compared to being married) was associated with a significantly shorter time until institutionalisation (univariate model: HR = 4.50, 95% CI 1.09 to 18.57). Of the dementia-free elderly individuals, 7.8% (n=59) were institutionalised during the study period. Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use. Conclusions Being without a spouse seems to be a predictor of institutionalisation in incident dementia cases. For dementia-free individuals, the effect of severe physical or psychiatric diseases and living alone on NHA is considerably increased.

Background Up to this date, prevalence rates of obesity are still rising. Aside from co-morbid diseases, perceived discrimination and stigmatization leads to worsen outcomes in obese individuals. Higher stigmatizing attitudes towards obese individuals may also result in less support of preventive and interventive measures. In light of the immense burden of obesity on health care systems and also on the individuals' quality of life, accepted and subsidized preventive measures are needed. Policy support might be determined by views of the lay public on causes of obesity and resulting weight stigma. This study seeks to answer how representative samples of the lay public perceive people with obesity or overweight status (stigmatizing attitudes); what these samples attribute obesity to (causal attribution) and what types of interventions are supported by the lay public and which factors determine that support (prevention support). Methods A systematic literature search was conducted. All studies of representative samples reporting results on (a) stigmatizing attitudes towards overweight and obese individuals, (b) causal beliefs and (c) prevention support were included. Results Only 7 articles were found. One study reported prevalence rates of stigmatizing attitudes. About a quarter of the population in Germany displayed definite stigmatizing attitudes. Other studies reported causal attributions. While external influences on weight are considered as well, it seems that internal factors are rated to be of higher importance. Across the studies found, regulative prevention is supported by about half of the population, while childhood prevention has highest approval rates. Results on sociodemographic determinants differ substantially. Conclusions Further research on public attitudes toward and perception of overweight and obesity is urgently needed to depict the prevailing degree of stigmatization. Introducing a multidimensional concept of the etiology of obesity to the lay public might be a starting point in stigma reduction.

Background Depression is one of the most common mental disorders in old age. In order to assess future needs of the healthcare system for prevention and treatment, information on epidemiology of depression among the highest age groups is required. However, most previous studies just focused on prevalence and incidence rates of late life depression across the entire old age. Methods For a population-based sample of 1265 elderly individuals aged 75 years and older, prevalence and incidence rates as well as risk factors of depression were determined. Individuals were requested every 1.5 years over six waves. Depression was assessed dimensionally by the CES-D (Center of Epidemiologic Studies Depression Scale) and categorically by the SCID (Structured Clinical Interview for DSM-IV). The prevalence rates were 1.0% for Major Depression, 2.5% for Minor Depression according to DSM-IV and 38.2% for depressive symptoms according to CES-D. The rates increased for Minor and depressive symptoms with rising age. Risk factors were divorced or widowed marital status, low educational level, poor self-rated health status, stressful life events, and poor social network. The incidence rates were 6.9 per 1000 person-years (py) for Major Depression, 16.6 per 1000 py for Minor Depression and 33.9 per 1000 py for depressive symptoms. Discussion Since depressive symptoms are common in oldest age and associated with broad categories of risk factors, latest-life depression represents an important public health issue. Employment of comprehensive geriatric assessment to ascertain depressive symptoms and its concomitants could help to improve treatment success.

Background Early diagnosis of dementia requires knowledge about associated predictors. The aim of this study was to determine the impact of mild cognitive impairment (MCI) and impairment in instrumental activities of daily living (IADL) on the time to an incident dementia diagnosis. Methods Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based study of individuals aged 75 years and older. Kaplan-Meier survival analysis was used to determine time to incident dementia. Cox proportional hazards models were applied to determine the impact of MCI and impairment in IADL on the time to incident dementia. Results 180 (22.0%) of 819 initially dementia-free subjects developed dementia by the end of the study. Mean time to incident dementia was 6.7 years (95% CI 6.5 to 6.9). MCI combined with impairment in IADL was associated with a higher conversion rate to dementia and a shorter time to clinically manifest diagnosis. The highest risk for a shorter time to incident dementia was found for amnestic MCI combined with impairment in IADL: the mean time to incident dementia was 3.7 years (95% CI 2.9 to 4.4) and thus half as long as in subjects without MCI and impairment in IADL. Conclusions Subjects with MCI and impairment in IADL constitute a high-risk population for the development of dementia. The consideration of impairment in IADL should constitute an important step towards an MCI concept being clinically more useful for prediction of dementia.

Background In previous decades a substantial number of community-based studies mostly including dementia cases examined predictors of nursing home admission (NHA) among elderly people. However, no one study has analysed predictors of NHA for individuals without developing dementia before NHA. Methods Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,024 dementia-free older adults were interviewed six times on average every 1.4 years. Socio-demographic, clinical, and psychometric variables were obtained. Kaplan-Meier estimates were used to determine mean time to NHA. Cox proportional hazards regression was used to examine predictors of long-term NHA. Results Of the overall sample, 7.8 percent of the non-demented elderly (n = 59) were admitted to nursing home (NH) during the study period. The mean time to NHA in the dementia-free sample was 7.6 years. Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use. Conclusions Severe physical or psychiatric diseases and living alone have a significant effect on NHA for dementia-free individuals. The findings offer potentialities of secondary prevention to avoid or delay NHA for these elderly individuals. Further investigation of predictors of institutionalization is warranted to advance understanding of the process leading to NHA for this important group.

BACKGROUND Inadequate recognition of depression in old age in primary care and the consequences for individuals are now well reported, but little research has been undertaken on its impact on healthcare costs. It is not known whether these costs (i) differ between GP-recognized and -unrecognized depressed individuals, and (ii) differ between these groups and non-depressed individuals. METHODS 451 primary care patients aged 75+ were interviewed face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score), resource utilization and healthcare costs (questionnaire of service utilization and costs). A general practitioner (GP) questionnaire was used to measure GPs' recognition of depression. Resource utilization was valued in monetary terms using 2004/2005 prices. RESULTS Thirty-eight (60%) of the 63 depressed patients were not identified by the GPs. From a societal perspective, mean annual healthcare costs were euro 5,582 for unrecognized depressed and euro 4,722 for recognized depressed patients with no significant difference. Healthcare costs of recognized and unrecognized depressed exceeded the healthcare costs of non-depressed patients (euro 3,648) by 23% and 35% respectively (p < 0.05). CONCLUSION Although mean annual healthcare costs for GP-unrecognized depressed patients exceed the costs of GP-recognized depressed patients in absolute numbers, differences were not found to be statistically significant. Both groups differ from non-depressed individuals regarding their healthcare costs. Results encourage further research into the effect of recognition on healthcare costs of depression in large-scale studies.

Summary Dementia is common and one of the most burdensome diseases for sufferers and their relatives; it is also one of the biggest challenges for the healthcare systems of aging societies. Professional nursing care and informal care by family or friends constitute the most significant cost components of dementia. In the absence of effective therapeutic options, a healthy lifestyle might be the best option to reduce the individual risk of developing dementia.

Background Most older adults want to live independently in a familiar environment instead of moving to a nursing home. Preventive home visits based on multidimensional geriatric assessment can be one strategy to support this preference and might additionally reduce health care costs, due to the avoidance of costly nursing home admissions. The purpose of this study was to analyse the cost-effectiveness of preventive home visits from a societal perspective in Germany. Methods This study is part of a multi-centre, non-blinded, randomised controlled trial aiming at the reduction of nursing home admissions. Participants were older than 80 years and living at home. Up to three home visits were conducted to identify self-care deficits and risk factors, to present recommendations and to implement solutions. The control group received usual care. A cost-utility analysis using quality-adjusted life years (QALY) based on the EQ-5D was performed. Resource utilization was assessed by means of the interview version of a patient questionnaire. A cost-effectiveness acceptability curve controlled for prognostic variables was constructed and a sensitivity analysis to control for the influence of the mode of QALY calculation was performed. Results 278 individuals (intervention group: 133; control group: 145) were included in the analysis. During 18 months follow-up mean adjusted total cost (mean: +4,401 EUR; bootstrapped standard error: 3,019.61 EUR) and number of QALY (mean: 0.0061 QALY; bootstrapped standard error: 0.0388 QALY) were higher in the intervention group, but differences were not significant. For preventive home visits the probability of an incremental cost-effectiveness ratio

Background Primary care practices provide a gate-keeping function in many health care systems. Since depressive disorders are highly prevalent in primary care settings, reliable detection and diagnoses are a first step to enhance depression care for patients. Provider training is a self-evident approach to enhance detection, diagnoses and treatment options and might even lead to improved patient outcomes. Methods A systematic literature search was conducted reviewing research studies providing training of general practitioners, published from 1999 until May 2011, available on the electronic databases Medline, Web of Science, PsycINFO and the Cochrane Library as well as national guidelines and health technology assessments (HTA). Results 108 articles were fully assessed and 11 articles met the inclusion criteria and were included. Training of providers alone (even in a specific interventional method) did not result in improved patient outcomes. The additional implementation of guidelines and the use of more complex interventions in primary care yield a significant reduction in depressive symptomatology. The number of studies examining sole provider training is limited, and studies include different patient samples (new on-set cases vs. chronically depressed patients), which reduce comparability. Conclusions This is the first overview of randomized controlled trials introducing GP training for depression care. Provider training by itself does not seem to improve depression care; however, if combined with additional guidelines implementation, results are promising for new-onset depression patient samples. Additional organizational structure changes in form of collaborative care models are more likely to show effects on depression care.