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Objectives The objectives were to describe the comorbidity between 12-month major depressive episode (MDE) and chronic physical condition (CPC) in Spain, a Latin country with relatively low prevalence of depression. Methods The European Study of Epidemiology of Mental Disorders (ESEMeD)-Spain is a cross-sectional, general-population, household survey representative of the Spanish noninstitutionalized adult population ( N =5473). The Composite International Diagnostic Interview was used for assessing mental disorders. CPCs were assessed among a subsample ( N =2121) with a standardized checklist. Logistic regression analysis was performed. ESEMeD-Spain is part of the World Health Organization World Mental Health Surveys. Results Among those with CPC, the prevalence of MDE was 5.9%, and the odds ratio (OR) of comorbid MDE was 2.2 compared with those without CPC. The strongest association with MDE was for respiratory disorders (OR up to 7.8). Having an MDE increased notably the odds of disability among those with a CPC (ORs ranged from 3.6 to 23.0). The likelihood of receiving treatment for the MDE was similar irrespective of having or not comorbid CPC. Conclusions Results show intense associations among MDE and CPC. Compared to other developed countries, higher likehoods of comorbidity and more severe impacts on disability are found in specific comorbid conditions. These findings highlight the need to improve the treatment of MDE in those with a CPC in Spain.

This study described use of services for a major depressive episode and determined factors associated with use in Spain, a country with universal access to care and a relatively low prevalence of depression.Data were from the European Study of the Epidemiology of Mental Disorders (ESEMeD). ESEMeD-Spain was a cross-sectional, general population survey conducted with a representative sample of noninstitutionalized adults (N=5,473). The Composite International Diagnostic Interview was used, and 12-month use of services for a major depressive episode, types of services used, and receipt of minimally adequate treatment were assessed.Among the 247 respondents with a major depressive episode in the past 12 months, 59% reported any use of past-year services for their disorder; of this group, 76% reported receipt of any active treatment (from a health care or mental health professional). Among respondents with severe depression, 31% used no services. A higher likelihood of service use was found among those who were unemployed or too disabled to work (OR=4.9, CI=1.3-19), who had moderate depression symptoms (OR=3.2, CI=1.1-9.0), and who had one mental disorder comorbid with depression (OR=2.9, CI=1.2-7.0) or two or more such comorbid disorders (OR=4.1, CI=1.9-8.9). In the active treatment group, only 31.2% received treatment that was minimally adequate.There is a need in Spain to increase use of services for a major depressive episode, especially among certain population groups, such as women, and to improve adequacy of treatments. The role of specific factors, such as availability of services and of professionals, deserves further research.

Rationale, aims and objectives The Sheehan Disability Scale (SDS) is a three-item instrument that measures disability in three inter-related domains: work, family life/home responsibilities and social/leisure activities. The main objective of the present study was to examine the factor structure, reliability and construct validity of the SDS in a wide Spanish sample of primary care (PC) patients. Methods One phase cross-sectional survey.Atotal of 3815 patients, aged 18 years or older attending PC for a medical visit, were interviewed between October 2005 and March 2006. The interviews included the Structured Clinical Interview for DSM-IVAxis I Disorders for depressive and anxiety disorders, the Mini-International Neuropsychiatric Interview for the rest of mental disorders, a medical conditions checklist, the 2.0 version of the 12-item Short-Form Health Survey (SF-12) for measuring quality of life and the SDS. Results The principal component analysis and the subsequent confirmatory factor analysis indicated that the SDS is one-dimensional (normed fit index = 0.990, non-normed fit index = 0.987, comparative fit index = 0.991, goodness-of-fit index = 0.993, standardized root mean-square residual = 0.037, root mean-square error of approximation = 0.053). The internal consistency of the scale was good ( a= 0.83) and it was significantly associated with the physical and mental component of the SF-12. Concerning discriminative validity, patients with major depression or panic disorder scored higher on the SDS than patients with chronic medical conditions or with no chronic pathology. We also found that a cut-off point of 8 in the SDS adequately discriminated between patients with and without depression (area under the curve = 0.814, sensitivity = 81.60%, specificity = 70.60%). Conclusions The SDS seems a reliable, valid and useful clinical tool for measuring disability in Spanish PC patients.

Objectives The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria. Methods Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed. Results GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP. Conclusion GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.

Dropping out from mental health treatment is a major problem because mental health treatments delivered for inadequate durations are ineffective. The aim of this study was to compare treatment dropout rates by type of provider, dropout risk by number of visit, and to ascertain factors associated with treatment dropout. A cross-sectional household survey of a representative sample of 626 out of 21,425 non-institutionalized adults from the general population of six European countries was carried out. Dropout was defined as terminating treatment before recommendation. Dropout from all treating providers during a 12-month period was 14%. Among psychiatrists, psychologists, and general practitioners figures were: 19.6, 20.3, and 20.3%, respectively. While the hazard risk for dropping out was higher during the first three visits to GPs and psychologists, it was stable for psychiatrists. Older age, female gender, and living in large or midsize urban areas were associated with a decreased risk of dropping out. Efforts for increasing patients’ proportion completing adequate courses of care for mental disorders in Europe should focus on the first visits, especially those made to the general medical care.

Background The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors. Aim To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition. Design of study One-phase cross-sectional study. Setting Seventy-seven primary care centres in Catalonia, Spain. Method A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used. Results The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor ‘GP’ was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively. Conclusion The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).

INTRODUCTION AND OBJECTIVES: The activity of behavioral inhibition and activation systems (BIS and BAS) has been related to several mental disorders. The availability of a validated questionnaire to assess BIS and BAS over the telephone could aid research. The objective of the present study was to evaluate the procedural validity of telephone administration of the sensitivity to punishment/sensitivity to reward questionnaire (SPSRQ) as a measure of BIS and BAS activity (by means of its two scales: the sensitivity to punishment [SP] scale and the sensitivity to reward [SR] scale). METHODS: A total of 231 participants were assessed with the SPSRQ twice (over the telephone and in a self-administered format). Intraclass correlation coefficients and kappa indices were calculated. Additionally, possible differences between the mean scores obtained with the two assessment procedures and internal consistency were explored. RESULTS: Telephone and self-assessment of BIS and BAS, by means of the SPSRQ, provided similar results, supporting the procedural validity of telephone administration. A slight but statistically significant tendency (estimated betha = 0.62; 95% CI, 0.33-0.92; p

ResumenObjetivoConocer el grado de coordinación/cooperación entre la atención primaria (AP) de Cataluña y los centros de salud mental de adultos (CSMA), los centros de atención y seguimiento a las drogodependencias (CASD) y los centros de salud mental infanto-juvenil (CSMIJ). Evaluar si hay diferencias en coordinación en función del carácter urbano o rural de los municipios.DiseñoEstudio descriptivo transversal.Emplazamiento80 centros de AP representativos de las 7 regiones sanitarias de Cataluña.ParticipantesSelección mediante muestreo aleatorio estratificado; 356 de los 618 médicos de familia a los que se ofreció participar completaron una encuesta que evaluaba diferentes aspectos de coordinación con los servicios especializados.ResultadosLos participantes indicaron un peor acceso a los CSMA que a los CASD y a los CSMIJ. Sin embargo, la formación proporcionada por los CSMA era mejor que la de los otros dos dispositivos en todos los indicadores empleados. No se hallaron diferencias significativas en las variables de acceso y formación entre zonas urbanas y rurales.ConclusionesLa cooperación entre la AP y los servicios especializados en salud mental de Cataluña es óptima en algunos aspectos. No obstante, sería conveniente que se redujera el tiempo de espera para las primeras visitas en los CSMA y que los CASD y los CSMIJ incrementaran las actividades de formación.AbstractsPurposeTo find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated.DesignCross-sectional descriptive study.SettingEighty PC centres representing the seven health regions of Catalonia.ParticipantsSelection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services.ResultsThe PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas.ConclusionsThe cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased.

Rationale Depressive disorders generate severe personal burden and high economic costs. Cost-utility analyses of the different therapeutical options are crucial to policy-makers and clinicians. Previous cost-utility studies, comparing selective serotonin reuptake inhibitors and tricyclic antidepressants, have used modelling techniques or have not included indirect costs in the economic analyses. Objective To determine the cost-utility of fluoxetine compared with imipramine for treating depressive disorders in primary care. Methods A 6-month randomized prospective naturalistic study comparing fluoxetine with imipramine was conducted in three primary care centres in Spain. One hundred and three patients requiring antidepressant treatment for a DSM-IV depressive disorder were included in the study. Patients were randomized either to fluoxetine (53 patients) or to imipramine (50 patients) treatment. Patients were treated with antidepressants according to their general practitioner’s usual clinical practice. Outcome measures were the quality of life tariff of the European Quality of Life Questionnaire: EuroQoL-5D (five domains), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and after 1, 3 and 6 months. Incremental cost-utility ratios (ICUR) were obtained. To address uncertainty in the ICUR’s sampling distribution, non-parametric bootstrapping was carried out. Results Taking into account adjusted total costs and incremental quality of life gained, imipramine dominated fluoxetine with 81.5% of the bootstrap replications in the dominance quadrant. Conclusion Imipramine seems to be a better cost-utility antidepressant option for treating depressive disorders in primary care.

Introduction and objectives: The activity of behavioral inhibition and activation systems (BIS and BAS) has been related to several mental disorders. The availability of a validated questionnaire to assess BIS and BAS over the telephone could aid research. The objective of the present study was to evaluate the procedural validity of telephone administration of the sensitivity to punishment/sensitivity to reward questionnaire (SPSRQ) as a measure of BIS and BAS activity (by means of its two scales: the sensitivity to punishment [SP] scale and the sensitivity to reward [SR] scale). Methods: A total of 231 participants were assessed with the SPSRQ twice (over the telephone and in a self-administered format). Intraclass correlation coefficients and kappa indices were calculated. Additionally, possible differences between the mean scores obtained with the two assessment procedures and internal consistency were explored. Results: Telephone and self-assessment of BIS and BAS, by means of the SPSRQ, provided similar results, supporting the procedural validity of telephone administration. A slight but statistically significant tendency (estimated betha = 0.62; 95% CI, 0.33-0.92; p < 0.001) toward lower scores was observed for the telephone-administered SP scale and for the interaction “first or second assessment/telephone or self-administered SPSRQ” for the SR scale (p = 0.023). Conclusions: The results of the present study support the reliability of telephone assessment of BIS and BAS by means of the SPSRQ.

Introduction and objectives Currently in Spain, 4 depot antipsychotics are available: flufenazine, pipotiazine, zuclopentixol and risperidone. The objectives of the present study are: a) to evaluate the efficacy of depot vs. oral forms of typical and atypical antipsychotics available in Spain for treating patients with schizophrenia; b) to compare the efficacy of different depot antipsychotics; c) to evaluate cost-effectiveness of typical and atypical depot and oral antipsychotics. Methods Systematic review of the literature between January 1980 and March 2007. Pharmaceutical companies of depot preparations were contacted aiming to include unpublished material. Results A total of 15 studies were included (13 journal manuscripts and 2 posters provided by the industry). Concordance between evaluators was moderate-high. The quality of selected studies was moderate-low. There were no differences in the efficacy between depot and oral risperidone. Efficacy of depot risperidone was higher than oral olanzapine (there were no differences regarding tolerability) and higher and better tolerated than oral zuclopentixol. The evidence was controversial when comparing the effi cacy of depot and oral flufenazine. There were no differences when comparing the efficacy between depot flufenazine and oral pimozide. Depot zuclopentixol was more effi cient than the oral preparation for treating patients with schizophrenia and violent behaviour. Finally, there were no differences regarding the effi cacy and tolerability between depot pipotiazine and depot flufenazine and between depot clopentixol and depot flufenazine. Conclusions There is few high-quality scientific evidence comparing depot and oral antipsychotics or different depot antipsychotics available in Spain. Selected evidence does not allow to conclude that depot antipsychotics are more effective and better tolerated than oral ones.

Different prevalence of non-affective psychosis has been reported in general population surveys. The objectives of this study were to describe lifetime prevalence of non-affective psychosis in Catalonia, Spain; and to analyze the use of the CIDI psychosis module as a screening instrument for psychotic disorders. As part of the ESEMeD project in Catalonia, 1645 respondents were assessed with the CIDI. Respondents who scored positively to any of the CIDI psychosis screen questions, who had been hospitalised for a psychiatric reason or had received antipsychotic medication were re-assessed with the SCID-I by a clinician. The results showed that 11.18% people of the sample had lifetime self reported psychotic symptoms using the CIDI. After a clinical interview with the SCID-I, between 0.85 and 2.37% of the sample had a psychotic disorder, and 0.48%–1.58% had schizophrenia. The most frequent reported psychotic symptoms in individuals without a psychotic disorder were those related with hearing or seeing something missing during a bereavement period. Experiencing mind control, feeling that your mind was being controlled by strange forces, experiencing attempts of communications (CIDI questions) and taking medication were the items that discriminate between non-affective psychosis cases and negatives. Only experiencing mind control was associated with psychotic disorders in a logistic regression analysis. The main conclusions are that the use of lay-administered interviews should only be used as a screening instrument in the detection of psychosis in general population surveys because the majority of self reported psychotic symptoms have not been found to be associated with a psychotic disorder. © 2008 Elsevier B.V. All rights reserved.

Objective: This study evaluated the adequacy of pharmacological antidepressant treatment in major depressive episodes prescribed in 16 Spanish primary care centers, both during the acute phase of treatment and after the first three months of the continuation phase, under realworld naturalistic conditions (usual care). Factors that could be associated with adequacy of care also were explored. Methods: A total of 333 patients from primary care who began pharmacological antidepressant treatment were followed up for six months. Treatment adequacy and associated factors were evaluated. Results: Between 27% and 32% of patients received adequate antidepressant treatment during the acute phase. Percentages of adequacy were between 21% and 25% when considering the acute phase and the first three months of the continuation phase. Psychiatric consultations were found to be associated with treatment adequacy. Conclusions: In state-funded Spanish primary care centers, antidepressant treatment adequacy was poor during both the acute phase and the first three months of the continuation phase. Primary care physicians prescribed suggested antidepressants, mostly as recommended (99%) and at adequate dosages. However, they did not perform the recommended number of follow-up sessions and treated patients with depressive disorders other than major depression as if they had a major depressive episode. Collaborative interventions between primary and specialized care could improve treatment adequacy. (Psychiatric Services 59:78–83, 2008)

Objective: To determine the cost–utility of selective serotonin reuptake inhibitors (SSRIs) for treating depressive disorders prescribed in primary care (PC). Method: A total of 301 participants beginning antidepressant treatment with an SSRI were enrolled in a prospective 6-month follow-up naturalistic study. Incremental cost–utility ratios (ICUR) were obtained for several comparisons among different SSRIs. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out. Results: Taking into account adjusted total costs and incremental quality of life gained, fluoxetine dominated paroxetine and citalopram with 63.4% and 79.3% of the bootstrap replications in the dominance quadrant, respectively. Additionally, fluoxetine was cost-effective over sertraline with 83.4% of the bootstrap replications below the threshold of 33,936 US$/quality-adjusted life year (30,000 €/QALY). Conclusion: Fluoxetine seems to be a better cost–utility SSRI option for treating depressive disorders in PC.

Fundamento y objetivo El dolor dorsal (DD) y el dolor cervical (DC) cronicos son muy prevalentes en la poblacion adulta. Sin embargo, poco se sabe respecto de su comorbilidad con otros procesos y su impacto sobre el funcionamiento global del individuo. El siguiente trabajo, que forma parte del estudio ESEMeD-Espana, tiene por objetivos estimar la prevalencia del DD-DC cronico en la poblacion espanola, su comorbilidad con otras enfermedades y trastornos fisicos y mentales, ademas de su impacto sobre el funcionamiento global. Sujetos y metodo Se realizo una encuesta personal domiciliaria a una muestra representativa de la poblacion espanola mayor de 18 anos compuesta por 5.473 individuos. Los entrevistados informaron de la presencia de DD-DC cronico y las enfermedades y trastornos comorbidos. Los trastornos mentales se evaluaron con la Composite International Diagnostic Interview y el funcionamiento global con la WHO Dissability Assessment Schedule. La tasa de respuesta fue del 78,6%. Resultados El DD-DC cronico presento una prevalencia-ano del 14,7%. Un 65,7% de las personas que lo presentaban refirio al menos una enfermedad/trastorno comorbido, ya fuesen otras enfermedades que implicaban dolor cronico (49,4%), enfermedades fisicas cronicas (40,7%), algun trastorno del estado de animo (7,9%), trastorno de angustia (1,3%), trastorno por estres postraumatico (1,5%) o ansiedad generalizada (1,4%). Ademas, el DD-DC cronico mostro un impacto negativo sobre el funcionamiento global. Sin embargo, las enfermedades y trastornos comorbidos explicaron casi un tercio de la asociacion entre DD-DC y funcionamiento global. Conclusiones El DD-DC cronico presenta una elevada prevalencia y comorbilidad con otras enfermedades y trastornos fisicos y mentales. Esta comorbilidad afecta negativamente al funcionamiento global de los individuos.

A number of theorists have proposed that the Behavioural Inhibition System (BIS) and the Behavioural Activation System (BAS) could be abnormal in subjects with depression. Subjects with major depression (MD) could show a hyperactive BIS and a hypoactive BAS. Individual differences in BIS and BAS activity were examined among depressed, recovered and non-depressed participants. Using the Sensitivity to Punishment and Sensitivity to Reward Questionnaire, 15 participants with current MD, 35 participants recovered from MD, and 30 non-psychiatric controls were assessed. Compared to non-psychiatric controls, participants with current MD showed a hyperactive BIS and a hypoactive BAS, while participants recovered from MD showed similar BIS activity and a hypoactive BAS. Overall, results suggest that a hypoactive BAS could be a trait–vulnerability marker for MD even after recovery.

BACKGROUND: Telephone assessment of depression for research purposes is increasingly being used. The Patient Health Questionnaire 9-item depression module (PHQ-9) is a well-validated, brief, self-reported, diagnostic, and severity measure of depression designed for use in primary care (PC). To our knowledge, there are no available data regarding its validity when administered over the telephone. OBJECTIVE: The aims of the present study were to evaluate agreement between self-administered and telephone-administered PHQ-9, to investigate possible systematic bias, and to evaluate the internal consistency of the telephone-administered PHQ-9. METHODS: Three hundred and forty-six participants from two PC centers were assessed twice with the PHQ-9. Participants were divided into 4 groups according to administration procedure order and administration procedure of the PHQ-9: Self-administered/Telephone-administered; Telephone-administered/Self-administered; Telephone-administered/Telephone-administered; and Self-administered/Self-administered. The first 2 groups served for analyzing the procedural validity of telephone-administered PHQ-9. The last 2 allowed a test-retest reliability analysis of both self- and telephone-administered PHQ-9. Intraclass correlation coefficient (ICC) and weighted κ (for each item) were calculated as measures of concordance. Additionally, Pearson’s correlation coefficient, Student’s t-test, and Cronbach’s α were analyzed. RESULTS: Intraclass correlation coefficient and weighted κ between both administration procedures were excellent, revealing a strong concordance between telephone- and self-administered PHQ-9. A small and clinically nonsignificant tendency was observed toward lower scores for the telephone-administered PHQ-9. The internal consistency of the telephone-administered PHQ-9 was high and close to the self-administered one. CONCLUSIONS: Telephone and in-person assessments by means of the PHQ-9 yield similar results. Thus, telephone administration of the PHQ-9 seems to be a reliable procedure for assessing depression in PC.

BackgroundWithin the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care.AimsTo estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs).MethodParticipants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories.ResultsThe prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription.ConclusionsAdjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).

PURPOSE: The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders. METHODS: Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated. RESULTS: In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders. CONCLUSIONS: Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens' mental health.

Objectives The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors. Methods An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed. Results GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased. Conclusion GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.

Mental disorders (MDs) are mainly treated in primary care (PC), where psychotropic drug (PSD) prescribing is highly prevalent. Prescription of PSD is associated with clinical and non-clinical factors.To describe the patterns of PSD prescribing over a 12-month period and to determine the factors associated with this in a PC population.Cross-sectional study. Data were collected on 3815 patients, via patient interview, on sociodemographics and MDs [Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria)]. Computerized records provided data on PSD prescribing. Multilevel logistic regressions assessed the factors that influence prescribing.Thirty-four per cent of PC patients were prescribed PSDs12 months, with anxiolytics being the most commonly prescribed (22%). Fifty-three per cent of patients with any MD in this 12-month period were prescribed PSDs; however, 25% of patients without any of these disorders were also prescribed these medications. Higher rates of prescribing were associated with female gender, older age, presence of MD, being a househusband/housewife, consulting about psychological problems, increasing number of consultations and higher self-perceived disability. PSDs were less likely to be prescribed to patients born outside Spain and those consulting about physical conditions. PSD prescribing was higher in patients previously married and antipsychotic prescribing was higher in patients never married. No statistically significant associations were found between PSD prescription and education.PSD prescribing rates are high in Catalonia and are associated with a number of clinical and non-clinical factors. A significant proportion of patients are receiving these drugs in the absence of MD. These findings need to be considered when prescribing in PC.

The Sheehan Disability Scale (SDS) is a three-item instrument that measures disability in three inter-related domains: work, family life/home responsibilities and social/leisure activities. The main objective of the present study was to examine the factor structure, reliability and construct validity of the SDS in a wide Spanish sample of primary care (PC) patients.One phase cross-sectional survey. A total of 3815 patients, aged 18 years or older attending PC for a medical visit, were interviewed between October 2005 and March 2006. The interviews included the Structured Clinical Interview for DSM-IV Axis I Disorders for depressive and anxiety disorders, the Mini-International Neuropsychiatric Interview for the rest of mental disorders, a medical conditions checklist, the 2.0 version of the 12-item Short-Form Health Survey (SF-12) for measuring quality of life and the SDS.The principal component analysis and the subsequent confirmatory factor analysis indicated that the SDS is one-dimensional (normed fit index = 0.990, non-normed fit index = 0.987, comparative fit index = 0.991, goodness-of-fit index = 0.993, standardized root mean-square residual = 0.037, root mean-square error of approximation = 0.053). The internal consistency of the scale was good (α = 0.83) and it was significantly associated with the physical and mental component of the SF-12. Concerning discriminative validity, patients with major depression or panic disorder scored higher on the SDS than patients with chronic medical conditions or with no chronic pathology. We also found that a cut-off point of 8 in the SDS adequately discriminated between patients with and without depression (area under the curve = 0.814, sensitivity = 81.60%, specificity = 70.60%).The SDS seems a reliable, valid and useful clinical tool for measuring disability in Spanish PC patients.

Background: Information of the epidemiology of Major Depressive Episode (MDE) in Spain, one of the biggest southern European countries, is scarce and heterogeneous. The objective of this study was to assess the epidemiology of the disorder in the Spanish sample of the ESEMeD project. Methods: The ESEMED-Spain project is a cross-sectional, general population, household survey conducted with a representative sample of Spanish non-institutionalized adult population. The survey instrument was the CIDI 3.0, a structured diagnostic interview to assess disorders and treatment. Results: Lifetime prevalence was 10.6% while 12-month prevalence was 4.0%. A monotonic increase in lifetime overall prevalence was found from the youngest to the 50–64 cohort, declining then in the oldest group. Median age of onset was 30.0. Being a woman (OR= 2.7), previously married (OR= 1.8), unemployed or disabled to work (OR= 2.9) was associated to higher risk of 12-month-MDE. The highest comorbid associations were with dysthymia (OR= 73.1) and panic disorder (OR= 41.8). Limitations: 1. Psychiatric diagnoses were made by trained lay interviewers and this could have an imperfect sensitivity/specificity; 2. Individuals with mental illness could have more frequently rejected to participate in the survey; 3. Age-related recall bias could have affected the accuracy of age of onset estimates. Conclusions: The study shows that prevalence MDE in Spain is lower than in other Western countries. Important findings are the early age of onset, the high proportion of chronicity, and the high female/male ratio. Taken together, results offer a complex picture of the epidemiology of MDE in Spain, when compared to other countries in Europe. The role of cultural factors is discussed. The ESEMeD project (http://www.epremed.org) was funded by the European Commission (Contracts QLG5- 1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028-02), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain. These activities were supported by the United States National Institute of Mental Health (R01MH070884, MH077883), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481)

Objective Previous epidemiological studies have revealed a high prevalence of mental disorders among primary care (PC) patients. However, most studies have methodological limitations (e.g. absence of structured clinical interviews, two-phase designs) that affect the generalizability of their results. The main objective of the present study was to estimate the lifetime and 12-month prevalence of mental disorders in the PC of Catalonia (Spain), using structured clinical interviews and a one-phase design. Methods One-phase cross-sectional survey. A representative probability sample without replacement of individuals aged 18 years or older attending PC for a medical visit were interviewed between October 2005 and March 2006. The interviews included SCID-I for depressive and anxiety disorders and the MINI interview for other mental disorders. A total of 3,815 patients from 77 PC centres were included in the statistical analyses. Results 45.1% of respondents reported at least one lifetime mental disorder and 30.2% reported at least one mental disorder in the previous 12 months. The most common mental disorders were major depression (9.6%), panic disorder (7.0%), specific phobia (6.6%), and generalized anxiety disorder (3.8%). There was a high comorbidity between mood and anxiety disorders, as well as between mental disorders and some chronic physical conditions. Conclusions There is a high prevalence and comorbidity of mental disorders in the PC of Catalonia. Public health policies should reinforce the role of family physicians in the detection and treatment of persons with mental disorders. © Springer-Verlag 2009., Study funded by the ‘‘Direcció General de Planificació i Avaluació Sanitària-Departament de Salut-Generalitat de Catalunya’’ (Barcelona, Spain). AF and JVL are grateful to the ‘‘Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III’’ (Red RD06/0018/0017) for a predoctoral and a postdoctoral contract, respectively.

Few data are available to estimate the prevalence of eating disorders (EDs) and their correlates in the community. This paper reports data on EDs obtained in the framework of the ESEMeD project, aimed at investigating the prevalence of non-psychotic mental disorders in six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain), using a new version of the Composite International Diagnostic Interview. The ESEMeD study was a general population cross-sectional household survey. In total, 21,425 respondents aged 18 or older provided data for the project between January 2001 and August 2003. A subsample (N=4139) underwent a detailed investigation on EDs. Lifetime estimated prevalence of anorexia nervosa, bulimia nervosa, binge eating disorder, sub-threshold binge eating disorder, and any binge eating were 0.48%, 0.51%, 1.12%, 0.72%, and 2.15%, respectively, and they were 3-8 times higher among women for all EDs. However, since people under 18 were excluded from this study, our prevalence should be taken as lower-bound estimate of real frequencies. Indeed, cumulative lifetime prevalence analysis showed that the majority of eating disorders had their initial onset between 10 and 20 years of age. Role impairment and comorbidity with other mental disorders were highly common, yet only small proportions of patients with a lifetime diagnosis of EDs requested medical treatment. It still has to be proven whether early diagnostic identification and access to specialized care can reduce the burden caused by these disorders. ispartof: Journal of Psychiatric Research vol:43 issue:14 pages:1125-1132 ispartof: location:England status: published

To estimate the comorbidity of mental disorders with chronic physical conditions and to assess their independent and combined effects on health-related quality of life (HRQOL). Face-to-face cross-sectional survey of adult attendants to public primary care (PC) centres from Catalonia (Spain). A total of 3,815 out of 5,402 selected patients provided data for this study. We report frequency of chronic physical conditions among participants with mental disorders and the contribution of each mental disorder and chronic physical condition to HRQOL. Chronic pain is the most frequent condition among those with mental disorders (74.54%). The effect of chronic physical conditions on HRQOL is rather minor when compared to the effect of mental disorders (especially mood disorders). However, chronic pain plays an important role in HRQOL loss. Mood disorders and chronic pain negatively affect HRQOL of PC patients. Especial efforts should be made to detect and treat mental disorders and chronic pain at this level.

The activity of behavioral inhibition and activation systems (BIS and BAS) has been related to several mental disorders. The availability of a validated questionnaire to assess BIS and BAS over the telephone could aid research. The objective of the present study was to evaluate the procedural validity of telephone administration of the sensitivity to punishment/sensitivity to reward questionnaire (SPSRQ) as a measure of BIS and BAS activity (by means of its two scales: the sensitivity to punishment [SP] scale and the sensitivity to reward [SR] scale).A total of 231 participants were assessed with the SPSRQ twice (over the telephone and in a self-administered format). Intraclass correlation coefficients and kappa indices were calculated. Additionally, possible differences between the mean scores obtained with the two assessment procedures and internal consistency were explored.Telephone and self-assessment of BIS and BAS, by means of the SPSRQ, provided similar results, supporting the procedural validity of telephone administration. A slight but statistically significant tendency (estimated betha = 0.62; 95% CI, 0.33-0.92; p0.001) toward lower scores was observed for the telephone-administered SP scale and for the interaction "first or second assessment/telephone or self-administered SPSRQ" for the SR scale (p=0.023).The results of the present study support the reliability of telephone assessment of BIS and BAS by means of the SPSRQ.

Currently in Spain, 4 depot antipsychotics are available: flufenazine, pipotiazine, zuclopentixol and risperidone. The objectives of the present study are: a) to evaluate the efficacy of depot vs. oral forms of typical and atypical antipsychotics available in Spain for treating patients with schizophrenia; b) to compare the efficacy of different depot antipsychotics; c) to evaluate cost-effectiveness of typical and atypical depot and oral antipsychotics.Systematic review of the literature between January 1980 and March 2007. Pharmaceutical companies of depot preparations were contacted aiming to include unpublished material.A total of 15 studies were included (13 journal manuscripts and 2 posters provided by the industry). Concordance between evaluators was moderate-high. The quality of selected studies was moderate-low. There were no differences in the efficacy between depot and oral risperidone. Efficacy of depot risperidone was higher than oral olanzapine (there were no differences regarding tolerability) and higher and better tolerated than oral zuclopentixol. The evidence was controversial when comparing the efficacy of depot and oral flufenazine. There were no differences when comparing the efficacy between depot flufenazine and oral pimozide. Depot zuclopentixol was more efficient than the oral preparation for treating patients with schizophrenia and violent behaviour. Finally, there were no differences regarding the efficacy and tolerability between depot pipotiazine and depot flufenazine and between depot clopentixol and depot flufenazine.There is few high-quality scientific evidence comparing depot and oral antipsychotics or different depot antipsychotics available in Spain. Selected evidence does not allow to conclude that depot antipsychotics are more effective and better tolerated than oral ones.

BACKGROUND: The aim of the present study is to compare suicide ideation among women in the pre-, peri-, and post-menopause using a cross-sectional household survey of non-institutionalised adults from six European countries. METHODS: In total, 8794 out of 21,425 respondents provided data for the following study. To use men as a comparison group, we defined three different groups of male subjects, based on the mean age of the women groups. RESULTS: We found an increased risk of suicide ideation among women in their peri-menopause compared with women in their pre- or post-menopause and men. This finding was independent of mood and anxiety disorders. LIMITATIONS: Some categories showed few individuals. The cross-sectional design of our study does not allow us to conclude causal relationship between variables. CONCLUSION: The occurrence of suicide ideation varies across the reproductive life cycle of women. ispartof: Journal of Affective Disorders vol:116 issue:1 pages:144-147 ispartof: location:Netherlands status: published

Background Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization's (WHO's) World Mental Health (WMH) Survey Initiative. Methods and Findings Household surveys with a combined sample size of 85,052 were carried out in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia (Japan, People's Republic of China), and Oceania (New Zealand). The WHO Composite International Diagnostic Interview (CIDI) was used to assess the prevalence and correlates of a wide variety of mental and substance disorders. This paper focuses on lifetime use and age of initiation of tobacco, alcohol, cannabis, and cocaine. Alcohol had been used by most in the Americas, Europe, Japan, and New Zealand, with smaller proportions in the Middle East, Africa, and China. Cannabis use in the US and New Zealand (both 42%) was far higher than in any other country. The US was also an outlier in cocaine use (16%). Males were more likely than females to have used drugs; and a sex–cohort interaction was observed, whereby not only were younger cohorts more likely to use all drugs, but the male–female gap was closing in more recent cohorts. The period of risk for drug initiation also appears to be lengthening longer into adulthood among more recent cohorts. Associations with sociodemographic variables were consistent across countries, as were the curves of incidence of lifetime use. Conclusions Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones. Sex differences were consistently documented, but are decreasing in more recent cohorts, who also have higher levels of illegal drug use and extensions in the period of risk for initiation., Louisa Degenhardt and colleagues report an international survey of 17 countries that finds clear differences in drug use across different regions of the world., Editors' Summary Background. Understanding how much disability and death a particular disease causes (known as the “burden of disease”) is important. Knowing the burden of a disease in a country contributes to the development of healthier nations by directing strategies and policies against the disease. Researchers' understanding of the burden of diseases across different countries was piecemeal until the 1990 launch of a special World Health Organization (WHO) project, the Global Burden of Disease Project. In 2002, on the basis of updated information from this ongoing project, the WHO estimated that 91 million people were affected by alcohol use disorders and 15 million by drug use disorders. Why Was This Study Done? It is widely accepted that alcohol, tobacco, and illegal drug use are linked with a considerable amount of illness, disability, and death. However, there are few high-quality data quantifying the amount across different countries, especially in less-developed countries. The researchers therefore set out to collect basic patterns of alcohol, tobacco, cannabis, and cocaine use in different countries. They documented lifetime use of these substances in each county, focusing on young adults. They also wanted to examine the age of onset of use and whether the type of drugs used was affected by one's social and economic status. What Did the Researchers Do and Find? Data on drug use were available from 54,069 survey participants in 17 countries. The 17 countries were determined by the availability of collaborators and on funding for the survey. Trained lay interviewers carried out face-to-face interviews (except in France where the interviews were done over the telephone) using a standardized, structured diagnostic interview for psychiatric conditions. Participants were asked if they had ever used (a) alcohol, (b) tobacco (cigarettes, cigars or pipes), (c) cannabis (marijuana, hashish), or (d) cocaine. If they had used any of these drugs, they were asked about the age they started using each type of drug. The age of first tobacco smoking was not assessed in New Zealand, Japan, France, Germany, Belgium, The Netherlands, Italy, or Spain. The interviewers also recorded the participants' sex, age, years of education, marital status, employment, and household income. The researchers found that in the Americas, Europe, Japan, and New Zealand, alcohol had been used by the vast majority of survey participants, compared to smaller proportions in the Middle East, Africa, and China. The global distribution of drug use is unevenly distributed with the US having the highest levels of both legal and illegal drug use among all countries surveyed. There are differences in both legal and illegal drug use among different socioeconomic groups. For example, males were more likely than females to have used all drug types; younger adults were more likely than older adults to have used all drugs examined; and higher income was related to drug use of all kinds. Marital status was found to be linked only to illegal drug use—the use of cocaine and cannabis is more likely in people who have never been married or were previously married. Drug use does not appear to be related to drug policy, as countries with more stringent policies (e.g., the US) did not have lower levels of illegal drug use than countries with more liberal policies (e.g., The Netherlands). What Do These Findings Mean? These findings present comprehensive and useful data on the patterns of drug use from national samples representing all regions of the world. The data will add to the understanding of the global burden of disease and should be useful to government and health organizations in developing policies to combat these problems. The study does have its limitations—for example, it surveyed only 17 of the world's countries, within these countries there were different rates of participation, and it is unclear whether people accurately report their drug use when interviewed. Nevertheless, the study did find clear differences in drug use across different regions of the world, with the US having among the highest levels of legal and illegal drug use of all the countries surveyed. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050141. Facts and figures on alcohol are available from the World Health Organization, including information about the burden of disease worldwide as a result of alcohol Information on the management of substance abuse is available from WHO Information on the Global Burden of Disease Project is also available from WHO Researchers from the University of New South Wales, Australia and the University of Queensland co-chair, sponsors the Global Burden of Disease Mental Disorders and Illicit Drug Use Expert Group, which examines illicit drug use and disorders The UN World Drug Report is available from the UN Office on Drugs and Crime The University of New South Wales also runs the Secretariat for the Reference Group to the United Nations on HIV and Injecting Drug Use

Suicide is a public health problem and it is increasing in Spain. The objective of this study is to analyze the prevalence and risk factors of suicide related outcomes (ideation, plan and attempt) using data from the ESEMeD-Spain project.This is a face-to-face household survey carried out in a probability representative sample of the adult general population of Spain. 5,473 subjects were interviewed using the Composite International Diagnostic Interview (CIDI 3.0), developed by the World Mental Health Survey Initiative.Lifetime prevalence of suicide ideation and attempts was 4.4% and 1.5%, respectively. Risk of suicide related outcomes was significantly higher among women (odds ratio [OR] = 2.3-2.7), younger cohorts (OR = 21.3-86), and lower education levels (OR = 5.3-6.4). Having a mental disorder was associated to an increased risk in all diagnostic categories, but especially in major depressive episode (OR = 5.3-6.8). Risk of suicide attempt was higher during the first year since the onset of ideation (OR = 30.2), decreasing thereafter.The prevalence of suicide related outcomes is low when compared with other countries. Results identified groups with higher risk (women, young, subjects with a mental disorder, psychiatric comorbidity and recent suicidal ideation) in which suicide prevention could show benefits.

Chronic back pain (CBP) and chronic neck pain (CNP) are highly prevalent among the adult population. However, less is known about its comorbidity with other diseases and its impact on global functioning. The objectives of following study, that is part of the ESEMeD-Spain study, are to estimate CBP-CNP prevalence among Spanish population, its comorbidity with other physical and mental conditions, and its impact on global functioning.Cross-sectional household survey of a representative sample of the population of Spain 18 years or older. Sample size was 5,473 individuals. CBP-CNP and comorbid conditions were ascertained by self-report. Mental disorders were ascertained with the Composite International Diagnostic Interview and global functioning with the WHO Dissability Assessment Schedule. Response rate was 78.6%.The one year prevalence of chronic CBP-CNP was 14.7%. A 65.7% of people with CBP-CNP reported at least one other comorbid condition, including other chronic pain conditions (49.4%), chronic physical conditions (40.7%), any mood disorders (7.9%), panic disorder (1.3%), posttraumatic stress disorder (1.5%) or generalized anxiety disorder (1.4%). Additionally, CBP-CNP negatively affected global functioning. However, comorbid conditions explained about one-third of the association between CBP-CNP and global functioning.CBP-CNP is highly prevalent and comorbid with other physical and mental conditions. Comorbidity negatively affects individuals global functioning.

Background Epidemiological surveys have consistently reported that the prevalence of major depression in women is almost twice as high as it is in men. While it seems that no major gender differences have been observed in the severity and symptomatology of depression, results regarding differences in antidepressant treatment response are controversial, especially when considering menopause in treatment response. Methods A total of 242 women (95 in their menopause), and 59 men beginning antidepressant treatment with a selective serotonin reuptake inhibitor (SSRI; Citalopram, Fluoxetine, Paroxetine or Sertraline) from 16 primary care (PC) centres were followed up during 6 months. Menopause effect and gender differences in antidepressant treatment response were evaluated. Additionally, severity and symptomatology of depression were compared among genders. Results Overall results suggest that menopause is related to a worse treatment response and to a poorer self-evaluation of global health status. No gender differences were observed in treatment response, depression severity, and symptomatology. Limitations Since our sample included PC participants, a wide spectrum of depression severity was considered. Additionally, menopause was assessed by means of participants' self-report. Conclusions Menopause seems to negatively affect SSRI treatment response of depressed women treated in PC.

Fundamento y objetivo El suicidio es un problema de salud publica y esta experimentando un notable aumento en Espana. El objetivo de este trabajo es el estudio de la prevalencia y los factores de riesgo de ciertos precursores del suicidio (ideacion, plan e intento de suicidio) a partir del proyecto ESEMeD-Espana. Sujetos y metodo Se ha realizado una encuesta personal domiciliaria a una muestra de 5.473 individuos representativos de la poblacion espanola mayor de edad. Se empleo el instrumento Composite International Diagnostic Interview (CIDI 3.0), desarrollado por iniciativa de Encuestas Mundiales de Salud Mental de la Organizacion Mundial de la Salud. Resultados La prevalencia de los precursores de suicidio fue del 4,4% (ideas) y del 1,5% (intentos). El riesgo asociado a los precursores del suicidio estudiados fue significativamente mayor en las mujeres (odds ratio [OR] = 2,3-2,7), las cohortes mas jovenes (OR = 21,3-86) y los niveles educativos menores (OR = 5,3-6,4). La presencia de un trastorno mental se asocio con un aumento del riesgo en todas las categorias diagnosticas estudiadas, especialmente alto en el episodio depresivo mayor (OR = 5,3-6,8). El primer ano desde el inicio de la ideacion fue el de mayor riesgo de realizar un intento (OR = 30,2), para disminuir a partir de entonces. Conclusiones La prevalencia de los precursores del suicidio estudiados es baja en comparacion con la obtenida en otros paises. Sin embargo, los resultados permiten identificar un grupo de mayor riesgo (mujer, joven, con enfermedad mental, comorbilidad psiquiatrica e ideacion suicida reciente) sobre el que intensificar la prevencion del suicidio en nuestra poblacion.

ResumenObjetivoConocer las opiniones sobre las guías de práctica clínica (GPC) para la depresión de médicos de atención primaria (AP), psiquiatras y psicólogos.DiseñoEstudio cualitativo, descriptivo-exploratorio basado en entrevistas semiestructuradas individuales y grupales.EmplazamientoCentros de AP y centros de salud mental de la red pública de Barcelona, Sabadell, Cornellà y Gavà.Participantes y contextoTreinta y un profesionales (10 médicos de AP, 11 psiquiatras y 10 psicólogos). Las entrevistas se realizaron en su lugar de trabajo o en la unidad de investigación de la institución donde se realizó el estudio entre octubre de 2007 y junio de 2008.MétodosMuestreo teórico y de conveniencia. Para garantizar la heterogeneidad se tuvo en cuenta el sexo, la edad, la experiencia y la pertenencia a diferentes instituciones. Grabación y transcripción de las entrevistas. Análisis de contenido. Triangulación de técnicas y contraste de resultado con los participantes.ResultadosLa principal utilidad de las GPC es que agilizan la toma de decisiones y dan seguridad. Como inconvenientes, se duda sobre la objetividad de las GPC y no se considera que las recomendaciones puedan aplicarse a sus pacientes. Los médicos de AP no conocían, en el momento del estudio, ninguna GPC para la depresión. Los especialistas sí conocen, pero no las utilizan al priorizar su experiencia.ConclusionesSe han detectado ideas erróneas sobre lo que es una GPC. Si se desea implementar una GPC, es necesario informar previamente sobre qué es una GPC, qué no es y para qué puede resultar útil.AbstractAimTo explore the views on clinical practice guidelines (CPG) of general practitioners (GP), psychiatrists, and psychologists.DesignDescriptive-exploratory qualitative study based on semi-structured individual and group interviews.SettingPublic primary health care and mental health centres in Barcelona, Sabadell, Cornellà de Llobregat and Gavà.Participants and contextA total of 31 health professionals (10GPs, 11 psychiatrists, and 10 psychologists) interviewed at their work place or at the research unit between October 2007 and June 2008.MethodConvenience sample. Participants were heterogeneous as regards sex, age, experience and workplace. Interviews were recoded and transcribed. Content analysis. Triangulation between techniques and results comparisons with participants was carried out as quality control.ResultsThe main advantages of CPGs were that they helped in decision making and gave security. On the other hand, participants were sceptical about the objectivity of GPC and considered that recommendations could not be applied to their individual patients. Additionally, they perceived CPG as inflexible. At the time of the study, GPs did not know of any CPG for depression. Specialists knew several CPGs but they did not use them as they prioritise their own experience.ConclusionsThere are some erroneous ideas about what a CPG is. If we want to implement CPGs, it is important to carry out some previous work presenting what a CPG is, what it is not and when it could be useful.