Background: Benzodiazepines are extensively used in primary care, but their long-term use is associated with adverse health outcomes and dependence.Aims: To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use.Method: A multicentre three-arm cluster randomised controlled trial was conducted, with randomisation at general practitioner level (trial registration ISRCTN13024375). A total of 532 patients taking benzodiazepines for at least 6 months participated. After all patients were included, general practitioners were randomly allocated (1:1:1) to usual care, a structured intervention with follow-up visits (SIF) or a structured intervention with written instructions (SIW). The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription claims at 12 months.Results: At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. After adjusting by cluster, the relative risks for benzodiazepine discontinuation were 3.01 (95% CI 2.03–4.46, P<0.0001) in the SIW and 3.00 (95% CI 2.04–4.40, P<0.0001) in the SIF group. The most frequently reported withdrawal symptoms were insomnia, anxiety and irritability.Conclusions: Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity. A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits.

Background. The underdiagnosis of depression is an important research topic. Nevertheless, overdiagnosis has not been given the importance it deserves by research into the ability of family physicians to diagnose depression correctly. Objectives. To identify the factors that determine the overdiagnosis of depression by family physicians and to evaluate the clinical significance of this error. Design. Two-phase cross-sectional study. Setting. Primary care centres in Tarragona (Spain). Methods. In the first phase, we screened 906 consecutive patients using Zung's self-rating depression scale (SDS). In the second phase, all the 209 patients with a positive screening and 97 patients with a negative screening (1 out of 7 randomly) were given the Structured Clinical Interview for DSM-IV Disorders, a series of questionnaires, and the family physician judged whether depression was present. In the 186 patients for whom there were no criteria of major depression or dysthymia, the association of various variables with the physicians' overdiagnosis of depression was analysed. Results. The rate of diagnosis of depression in non-depressed patients was 26.5% (95% CI: 19.0–33.9). The factors associated independently with overdiagnosis were the SDS score (OR: 1.05; 95% CI: 1.01–1.10), the Global Assessment of Functioning score (OR: 0.95; 95% CI: 0.90–0.99), previous history of depression (OR: 2.66; 95% CI: 1.12–6.30) and presence of generalized anxiety (OR: 0.42; 95% CI: 0.18–0.97). Conclusion. Family physicians classify as depressed those patients who do not have the formal signs of depression but who do have antecedents of this disorder or a psychological distress that may be prodromal of future depressive episodes.

Because the media influences society's perceptions of reality, the treatment of mental illness in the news can have an effect on the societal stigma related to it. This study aimed to analyze the content and form of news items related to mental illness in Spanish newspapers in order to understand their role in propagating or attenuating stereotypes, prejudices, and stigma. The authors conducted a cross-sectional descriptive study on the basis of a review of news items related to mental illness appearing in the Spanish print media. A sample was taken from articles published on the subject in the 20 Spanish newspapers with the widest circulations over the course of the year 2010. Formal elements and content were analyzed by means of a structured evaluation system. The authors analyzed 695 news items. The content of 47.9% (n = 333) of the articles was not strictly related to mental illness, but rather clinical or psychiatric terms were used metaphorically, and frequently in a pejorative sense. The remaining 52.1% (n = 362) consisted of news items related specifically to mental illness. Of these, news items linking mental illness to danger were the most common (178 texts, 49.2%), specifically those associating mental illness with violent crime (130 texts, 35.9%) or a danger to others (126 texts, 34.8%). The results confirm the hypothesis that the press treats mental illness in a manner that encourages stigmatization. The authors appeal to the press's responsibility to society and advocate an active role in reducing the stigma towards mental illness.

Objective: Depressive disorders are considered to be a public health problem. Primary health care plays an important role in the treatment of such disorders. Our aim is to determine the prevalence and determinant factors of major depression and dysthymia in consecutive primary care attenders. Method: The study took place in medical consultations in 10 Primary Care Centers in Tarragona (Spain). It was designed as a two-phase cross-sectional study. In the first phase we screened 906 consecutive patients according to Zung's Self-Rating Depression Scale. In the second phase the 209 patients whose results were positive and 97 patients whose results were negative (1/7 chosen at random) were given the Structured Clinical Interview for DSM-IV Axis I Disorders, plus a series of questionnaires. We evaluated the link between major depression and dysthymia and several sociodemographic and clinical variables using non-conditional logistic regression. Results: Weighted prevalence was 14.3% (CI 95%: 11.2–17.4) for major depression and 4.8% (CI 95%: 2.8–6.8) for dysthymia. Independently linked to the presence of major depression were female sex, panic disorder, generalized anxiety disorder, frequency of primary care visits, and clinical presentation in the form of explicitly psychosocial symptoms as opposed to exclusively somatic symptoms. Independently linked to the presence of dysthymia were age, generalized anxiety disorder and psychosocial symptoms. Conclusion: In our area, depressive disorders in primary care attenders are very common. General practitioners should be aware of this fact so that these disorders can be detected and treated correctly.

To investigate the relationship between the characteristics of somatic symptoms and depression severity, quality of life (QOL), and health resources utilization in patients with major depressive disorder (MDD) in primary care setting. This cross-sectional, nationwide epidemiologic study, carried out in 1150 primary care patients with DSM-IV-defined MDD, evaluated the characteristics of somatic symptoms by means of the Standardized Polyvalent Psychiatric Interview. Depression severity and QOL were evaluated by means of the Zung Self-Rating Depression Scale (SDS) and the Physical and Mental Component Summaries of the Medical Outcomes Study 12-item Short-Form Health Survey. Health resources utilization was measured in terms of doctor consultations and hospitalizations. The associations were assessed by means of adjusted analyses. The study was carried out from April 2004 to July 2004. Disability associated with somatic symptoms and number of somatic symptoms were strongly associated with increased depression severity (2.45 and 0.29 increase in SDS score, respectively) and health resources utilization (odds ratios of 1.42 and 1.04, respectively). Associated disability, frequency, and persistence during leisure time of somatic symptoms were strongly associated with poorer QOL. In contrast, we found a weaker relationship between duration and intensity of somatic symptoms and depression severity, QOL, and health resources utilization. Of the studied somatic symptom characteristics, somatic symptom-associated disability and number of somatic symptoms are strongly associated with increased depression severity and health resources utilization, as well as with decreased QOL. Our results may help physicians identify relevant characteristics of somatic symptoms to more effectively diagnose and treat depression in primary care patients.