***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Detection rates of depression in primary care are < 50 % . Studies showed similar outcome after 12 months for recognized and unrecognized depression . Outcome beyond 12 months is less well studied . OBJECTIVE We investigated recognition of depression in primary care and its relation to outcome after 6 , 12 and 39 months . METHODS Data were used from a prospect i ve cohort study of 1293 consecutive general practice attendees ( PREDICT-NL ) , who were followed up after 6 ( n = 1236 ) , 12 ( n = 1179 ) and 39 ( n = 752 ) months . We measured the presence and severity of major depressive disorder ( MDD ) according to DSM-IV criteria and Patient Health Question naire 9 ( PHQ-9  ) and mental function with Short Form 12  (  SF-12 ) . Recognition of depression was assessed using international classification of primary care codes ( P03 and P76 ) and Anatomical Therapeutic Chemical ( N06A ) codes from the GP records ( 6 months before/after baseline ) . RESULTS At baseline , 170 ( 13 % ) of the participants had MDD  , of whom 36 % were recognized by their GP . The relative risk of being depressed after 39 months was 1.35 [ 95 % confidence interval ( CI ) 0.7 - 2.7 ] for participants with recognized depression compared to unrecognized depression . At baseline , participants with recognized depression had more depressive symptoms ( mean difference PHQ-9 2.7 , 95 % CI 1.6 - 3.9 ) and worse mental function ( mean difference mental component summary -3.8 , 95 % CI -7.8 to 0.2 ) than unrecognized depressed participants . After 12 and 39 months , mean scores for both groups did not differ but were worse than those without depression . CONCLUSIONS A minority of patients with MDD is recognized in primary care . Those who were unrecognized had comparable outcome after 12 and 39 months as participants with recognized depression Background . Depression is a major reason for counselling in primary care . Our study aims at evaluating pharmacological treatment strategies among physicians specialised in anthroposophic medicine ( AM ) . Methods . From 2004 to 2008 , twenty-two German primary care AM-physicians participated in this prospect i ve , multicentre observational study . Multiple logistic regression was used to determine factors associated with a prescription of any antidepressant medication . Results . A total of 2444 patients with depression were included ( mean age : 49.1 years ( SD : 15.4 ) ; 77.3 % female ) . 2645 prescriptions of antidepressants for 833 patients were reported .  Phytotherapeutic preparations from Hypericum perforatum were the most frequently prescribed antidepressants over all ( 44.6 % of all antidepressants ) , followed by amitriptyline ( 16.1 % ) . The likelihood of receiving an antidepressant medication  did not depend on comorbidity after controlling for age , gender , physician specialisation , and type of depression ( adjusted OR ( AOR ) = 1.01 ; CI : 0.81–1.26 ) . Patients who had cancer were significantly less likely to be prescribed an antidepressant medication  than those who had no cancer ( AOR = 0.75 ; CI : 0.57–0.97 ) . Conclusion . This study provides a comprehensive analysis of everyday practice for the treatment of depression in AM -physicians . Further analysis regarding the occurrence of critical combinations is of high interest to health services research OBJECTIVE AND DESIGN To evaluate a cohort of patients with major depression to examine the effect of competing dem and s on depression care during multiple visits over 6 months . PARTICIPANTS AND SETTING Ninety-two patients with 5 or more symptoms of depression and no recent depression treatment were evaluated by 12 primary care physicians in 6 practice s in the usual-care arm of an effectiveness trial of the Agency for Health Care Policy and Research Depression Guidelines . MAIN OUTCOME MEASURE Treatment was considered to be initiated if the patient reported starting a guideline -concordant antidepressant medication or making a visit for specialty counseling . Treatment completion was defined as either a 3-month course of guideline -concordant antidepressant use or completion of 8 or more specialty counseling visits . RESULTS Among the 92 patients reporting no recent treatment at study enrollment , 57 % reported starting and 17 % reported completing a course of guideline -concordant antidepressant medication and or specialty counseling at the 6-month interview . The severity of physical problems among patients with high enthusiasm for depression treatment decreased the odds that patients would initiate  depression therapy .  Severity of physical problems had no observable effect on completing  depression therapy  in the group of patients who initiated treatment . CONCLUSIONS Physical problems compete with depression for attention over multiple visits in untreated patients who are enthusiastic about getting care for their emotional problems . Interventions are needed for this high-risk group , because depression treatment could potentially enhance patients ' treatment of their physical problems . Arch Fam Med . 2000;9:1059 - BACKGROUND General practitioners ( GPs ) are widely reported to ' miss ' half of the psychological problems present in their patients . AIMS To describe the relationship between frequency of consultations and GP recognition of psychological symptoms . DESIGN OF STUDY Survey of GPs and their patients . SETTING General practice s in the southern part of New Zeal and 's North Isl and . METHOD Participants were r and omly selected GPs ( n = 70 ) , and their patients ( n = 3414 , of whom a sub-set of 386 form the basis of this study ) . The main measure was the comparison between GP and composite international diagnostic interview ( CIDI ) recognition of psychological problems . RESULTS Of the GPs selected , 90 % participated . The CIDI was completed by 70 % of selected patients . In patients ( n = 386 ) with a CIDI-diagnosed disorder , 63.7 % ( 95 % confidence interval [ CI ] = 53.3 to 74.1 ) were considered by the GP to have had psychological symptoms in the last year ; 40.1 % ( CI = 31.0 to 49.2 ) to have had clinical ly significant psychological problems , and 33.8 % ( CI = 24.9 to 42.6 ) were given an explicit diagnosis . However , in those CIDI-diagnosed patients who had been seen five or more times during the previous year , these recognition figures increased to 80.2 % ( CI = 68.9 to 91.4 ) , 59.4 % ( CI = 45.9 to 72.9 ) and 53.6 % ( CI = 40.1 to 67.1 ) respectively , and dropped to 28.8 % ( CI = 13.0 to 44.7 ) , 13.6 % ( CI = 3.4 to 23.7 ) , and 10.7 % ( CI = 1.4 to 19.9 ) among patients not consulting during the previous year . GPs often differed from the CIDI in their assessment of clinical significance and diagnosis . CONCLUSION GP non-recognition of psychological problems was at a problematic level only among patients with little recent contact with the GP . Efforts to improve GP recognition of mental disorder may be more effective if they target new or infrequent attenders , and encourage patient disclosure of psychological issues The aims of the present study were to evaluate the extent to which primary care physicians ' ( PCPs ) identification of psychiatric distress is related to a number of nonpsychopathological factors , such as patient sociodemographic and health-related characteristics , and to assess the impact of depression on PCP identification of psychiatric distress , controlling for patient sociodemographic and health-related characteristics . Two patient sample s were chosen to explore these issues : 1 ) patients not fulfilling any ICD-10-defined or subthreshold psychiatric diagnosis and , 2 ) patients with an ICD-10 diagnosis of current depression . Patients attending 46 primary care clinics during an index period were screened by the General Health Question naire (GHQ)-12 and selected for a second stage interview according to GHQ score . Among the 559 interviewed patients , 123 had no mental disorder and 66 had an ICD-10 current depressive disorder . Identification of psychiatric distress by the PCP was associated with retirement among subjects without mental disorders but not among depressed patients . Patient 's negative overall health self-perception and severity of physical illness were significantly related to identification of psychiatric distress in the two groups , whereas neither disability nor reason for medical consultation had a significant effect . Patients with current depression , compared with those without , were 4.3 times more likely to be identified by PCPs as having psychiatric distress when adjusting for all the above nonpsychopathological variables . Patients with depression and comorbid anxiety disorders were more likely to be recognized by the PCP as compared with those with pure depression . Finally , among depressive symptoms , diurnal variation and symptoms related to suicidal tendencies were predictive of identification of psychiatric distress , whereas increase of appetite was negatively associated with PCP recognition 
    Output:
    
Chronic physical comorbidity burden does not consistently affect depression recognition negatively in primary care .
Instead , recognition seems to vary depending on the specific conditions or combination of conditions examined .