Journal of Affective Disorders 72 (2002) 53–59 www.elsevier.com / locate / jad Research report The identification of depression and the coverage of antidepressant drug prescriptions in Italian general practice a, a a a * Cesario Bellantuono , Maria Angela Mazzi , Michele Tansella , Raffaella Rizzo , b David Goldberg a The Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Ospedale Policlinico, 37134 Verona, Italy b Institute of Psychiatry, King’ s College, London, UK Received 1 February 2001; received in revised form 3 July 2001; accepted 17 July 2001 Abstract Background: Studies on antidepressant prescriptions in general practice need to assess the level of prescriptions relative to the need for them (‘coverage’), and the variability among doctors. Methods: Two different cut-off scores on a screening test for depression (the Personal Health Questionnaire, PHQ) are used to predict rates for depression, and rates for depressive patients thought likely to benefit from antidepressants (according to a severity criterion) in primary care patients. These two rates are compared with assessments by 11 GPs of recognised depression, as well as with rates of drug prescribed. Results: The rate for depression thought likely to be treated with antidepressants estimated with the PHQ is broadly comparable with the rate for conspicuous depressive illness, and much lower than that predicted by the PHQ for depression. There was great variability between GPs in their ability to detect depression, and their preparedness to prescribe antidepressants. Antidepressants were only prescribed for 3.5% of the patients, compared to the 8.9% thought to need them. However, antidepressants, mostly SSRIs, are much more likely to be prescribed than tranquillisers. Limitations: The limitations of the study are that the PHQ is able to estimate ‘coverage’ but not ‘focusing’ (the proportion of those receiving antidepressants who needed them). Conclusions: Although the rate for conspicuous depression is similar to that for depressions thought to be treated with antidepressants, the ‘coverage’ of antidepressants was only 39.3%. The variability between physicians confirm the need of good practice guidelines and training packages for the identification and management of depression. Large epidemiological studies are needed to overcome the current lack of clinically relevant data on the quality of antidepressant prescriptions in general practice.  2002 Elsevier Science B.V. All rights reserved. Keywords: Depression; Antidepressants; General practice 1. Introduction titioners (GPs) both under-diagnose and under-pre- scribe for patients with depression (Paykel and It has frequently been asserted that general prac- Priest, 1992; Katon et al., 1992; Goldberg et al., 1998; Simon and Ludman, 2000). Part of the reason for this has been the assumption by psychiatrists that *Corresponding author. Tel.: 139-45-807-4441; fax: 139-45- all those with an ICD-10 diagnosis should receive 585-871. E-mail address: bellant@galactica.it (C. Bellantuono). treatment for depression, which in the context of 0165-0327 / 02 / $ – see front matter  2002 Elsevier Science B.V. All rights reserved. PII: S0165-0327(01)00418-9