Depression in primary care

Project Department: Uni Research Health (group: Research Unit for General Practice in Bergen) period: from 01.09.16

About the project

Depression is a leading cause of suffering and disability in the Norwegian population.  However, little is known about patient trajectories through health care services and social security benefits.

The main objective of this research project is to investigate variations, pathways and experiences in GPs’ depression care in the framework of the Norwegian Regular General Practice (RGP) Scheme and the consequences for patients’ work participation.

Depression is a core challenge to society. Depressive disorders require person-centred, coordinated and prolonged health care services with particular attention to the risk of exclusion from work life. General practitioners (GPs) play a key role in this collaborative care, but it is not known whether the RGP Scheme ensures equity in the delivery of GPs’ depression care, and which GP services facilitate work participation among patients with depression.

The project follows two lines of inquiry:

•             We will examine the effectiveness of the RGP Scheme to deliver equitable depression care facilitating work participation among patients with depression, including comparative analyses of GP services between Norway and the Netherlands. We have received permission to link several national health and welfare registries, and these fully anonymised registries provide the empirical base for the studies.

•             We will investigate barriers and facilitators for GPs’ delivery of coordinated depression care. Here, crucial users such as patients and NAV counsellors will provide insight into the collaborative processes through focus group discussions, interviews, and a questionnaire to a national sample of GPs.

The project will provide new knowledge of the impact of the RGP Scheme for integrated and equitable pathways of GPs’ depression care and what pathways promote work participation. Moreover we will gain new knowledge about ways of organising services that are associated with better health care delivery, and this may inform future development of service organisation in Norway.

We have appointed a user group with representatives from patient organisations and various health professionals that has an important role in planning and carrying out the project, and disseminating the results.

The project is funded by the Research Council of Norway (Grant number 287884).

Project leader: Sabine Ruths.

Project participants: Inger Haukenes (AFE and University of Bergen), Stefan Hjørleifsson (UoB and AFE), Norman Anderssen (UoB and UoB), Tone Smith-Sivertsen (AFE and Haukeland University Hospital), Øystein Hetlevik (UoB and AFE), Valborg Baste (NORCE Health), Øystein Ariansen Haaland (UoB), Ina Grung (AFE), Anneli Hansen (AFE), Sharline Riiser (AFE) and Sara Tahir (AFE).


Patients’ experiences with management of depression by their general practitioner

In this project, we have conducted a web-based qualitative survey about how Norwegian patients experience the help they receive from their general practitioner when consulting for depressive symptoms. In August 2017, we received a response from approximately 260 informants whom we recruited through the homepage of the Norwegian patient organization Mental helse (Mental health). The project is due to finish in 2019.

Our point of departure is that patient experiences and judgements of how the help their general practitioners provide when they consult for depressive symptoms can usefully supplement professional conceptions of health service delivery.

There is very limited scientific knowledge about the prevalence, severity and management of depressive symptoms in general practice. Several studies indicate that general practitioners tend to overdiagnose as well as underdiagnose depression. On the other hand, the argument can also be made that patients in general practice are in need of different approaches than those endorsed in treatment guidelines that mainly are based on research from secondary care.

In our survey we have queried the patients about the help they have received from their general practitioner, their preferences about help, and the general practitioner’s cooperation with other professionals (including social security and the patients’ employer).

General practitioner Ina Grung is the primary researcher in this project. Grung is funded by a grant from The Norwegian Committee on Research in General Practice. Stefán Hjörleifsson and Norman Anderssen are Grung’s supervisors.


Medical treatment of depression in primary health care: the impact of social inequality

In the Norwegian welfare state, equity in health care is a fundamental principle. Patients of all ages and income groups consulting the GP should be treated in accordance with the principle of equity.

Patients with depression are commonly treated with medication. About 7% of the general population in Norway is prescribed antidepressant medication. Some 80% of antidepressants are prescribed by GPs, most commonly to women and older people. This pattern gives reason for concern as the empirical evidence for medication with respect to mild and moderate depression is weak. 

In this study we will examine to what extent gender, age, immigrant background and socioeconomic status influence GP’s prescription to patients with depression. The data source is a linkage between comprehensive national registries. 

Improving the knowledge of GPs prescription practice in cases of depression is one step in the direction of securing all patients evidence based treatment.

The project is funded by a grant from the Norwegian Medical Association (AFU).

Research fellow: Anneli Hansen (general practitioner in Bergen). Supervisors:  Sabine Ruths and Inger Haukenes.


GP consultations: importance for work participation among patients with depression

Depression ranks as the leading cause of health loss and disability worldwide. The condition often has an early debut, meaning that the younger part of the population is particularly vulnerable for major loss of working years. Moreover, depression is associated with frequent and long-term sickness absence spells and is highly prevalent among diagnoses leading to disability pension. Depression has huge cost for the individual and society, in terms of suffering, marginalisation and social security benefits.  

The GP has a key role in follow-up of patients with depression, including assessment and treatment as well as considerations regarding work ability. About 130 000 patients consult the GP for depression annually. There is, however, a significant lack of knowledge with respect to the role of the GP in treatment and follow-up of patients with depression.

In this study we will examine the relationship between GP-consultations for patients with a new episode of depression and work participation the following 12 months. The data source is a linkage between comprehensive national registries. The results may provide new knowledge on the importance of the GP consultation for work participation among patients with depression.

The project is funded by a grant from the Norwegian Medical Association (AFU).

Research fellow: Sharline Riiser (general practitioner in Sogndal). Supervisors:  Sabine Ruths and Inger Haukenes.


Norwegian Primary Care Research Network and Music Therapy for Depression in Primary Health Care

International research shows good effects of music therapy on depression, but the establishment of music therapy practice in Norway is still inadequate. There is also a need to evaluate the effect of different ways of practicing music therapy in depression. This is a pilot study preparing the ground for a larger randomized controlled multicenter study.

An aim of the study is also to pilot the Practice Based Research Network in Primary Health Services (Praksisnett), a new infrastructure that will enable researchers to conduct good and quality assurance studies in Norwegian public practice. PraksisNett gives the general practitioners the opportunity to participate in research in a predictable and safe manner. In this study, we use PraksisNett West to study the prevalence of depression and different treatment strategies in general practice.

Wes hall conduct a pilot study on the effect of music therapy in patients with depression, recruiting 6 patients in general practice through PraksisNett West. Patients are tested using standardized diagnostic tools (MADRS, HADS, GAF and RAND-36) and music therapy is implemented in 6 patients referred from their general practitioner (12 sessions over 6 weeks), with or without reinforcement elements. After attending music therapy, participants will be follow up with standardized diagnostic tools.

The project is a collaboration between the Research Unit for General Practice in Bergen  and the Grieg Academy Music Therapy Research Center (GAMUT), with funding from NORCE (project # 812369).

The project team consists of Sabine Ruths, Knut-Arne Wensaas, Nina Lunde og Tone Smith-Sivertsen (AFE) and  Christian Gold, Brynjulf Stige og Monika Geretsegger (GAMUT, NORCE).


Updated: June 2019

cp: 2019-12-04 11:16:25