General Practitioner (gp) Recognition of Depression and Anxiety

Pain and chronic somatic diseases often accompany depressive and anxiety disorders in the general population. Co-morbidity of physical and mental ill health often leads to a high burden at a personal level due to problems with treatment adherence, decreased treatment response, and social and occupational disability, and also to a huge societal burden due to loss in work days and high health care costs. There is ample evidence that depressive disorders, and to a lesser extent anxiety disorders, exert a negative effect on the course and outcome of pain and several chronic somatic diseases. By contrast, the effect of pain symptoms and chronic somatic diseases on depressive and anxiety disorders over time is not well studied. This thesis focused on the longitudinal associations between pain (by location, duration, severity as assessed by self-report during an interview) and depressive and anxiety disorders, and also on the longitudinal associations between self-reported chronic somatic diseases (such as cardiovascular, pulmonary or rheumatic disease) and depressive and anxiety disorders. Data were derived from the Netherlands Study of Depression and Anxiety (NESDA) examining 2981 participants aged between 18 and 65 selected to study the long-term course of depressive and anxiety disorders. By answering the following questions we hoped to provide a more in-depth insight into the role of physical health problems – pain and specific chronic somatic diseases on depression and anxiety over time in order to guide future prevention and treatment strategies and consequently reduce this public health burden. Are (particular) physical health problems associated with recognition of depressive and anxiety disorders by general practitioners? Are pain symptoms and (particular) chronic somatic diseases associated with the onset, presence and prognosis of depressive and anxiety disorders? And how do changes in depressive and anxiety disorder course affect changes in pain over time?