Existing psychological problems predict depression in primary care better than sociodemographic factors.

This is one of a number of reports due to emerge from WHO's recently completed study of the frequency, recognition, management and outcome of mental disorder in primary care. Spread over 14 countries, the study's size and sophistication are breath-taking. Screening tools and diagnostic instruments were reliable and valid; contact rates initially, and at one-year follow-up, were acceptable, and the results are reported in detail. Findings from this report, which focuses on risk factors for new depressive episodes, are mostly predictable. People at greatest risk of developing ICD-10 depressive disorders over a 1-year period were those with some other mental disorder at baseline, a history of depression and repeated suicidal thoughts. Thus, mental disorders in the community are often co-morbid, chronic and relapsing. Negative results are more notable here than positive ones. Women were at no greater risk of new-onset depression than men, despite their higher rate of depression in most prevalence studies. Age had no apparent bearing, despite the lower rates of depression in older people reported in other studies. The most likely explanation is that women and younger people remain unwell for longer periods once mental disorder strikes. Such subtleties will become clear only when the full results of this study are presented. Large-scale studies like this serve a genuine sociopolitical purpose: politicians and managers are reminded that mental disorder is common, persistent and disabling. At the same time, broad-brush investigations might miss the subtle personal and communal influences that alter the risk of depression in particular communities. Daniel O'Connor, MD, FRANZCP Professor of Psychiatry of Old Age Monash University Melbourne, Australia Source of funding: None listed.