Communicative skills of general practitioners augment the effectiveness of guideline-based depression treatment

Background: Although good physician communication is associated with positive patient outcomes. it does not figure in current depression treatment guidelines. We examined the effect of depression treatment. communicative skills and their interaction on patient outcomes for depression in primary care.

Methods: In a cohort of 348 patients with ICD-10 depression in primary care, patient outcomes were studied over 3- and 12-month follow-ups. The association of these outcomes with both depression-specific process of care variables and a nonspecific variable-communicative skillfulness of GP-was examined. Patient outcomes consisted of change from baseline in symptomatology, disability, activity limitation days, and duration of the depressive episode.

Results: In accordance with treatment guidelines, some main effects of depression treatment were found. in particular on symptomatology, but these remained small (effect size

Limitations: The study is observational and does not permit firm conclusions about causal relationships. Communicative. skillfulness of the GP was assessed by patient report only.

Conclusion: Neither depress ion-specific interventions nor good GP communication skills seem to be sufficient for optimal patient improvement. Only the combination of treatments according to guidelines and good communication skills results in an effective antidepressive treatment. (C) 2004 Elsevier B.V. All rights reserved.