In his provocative leading article, Professor Chris Dowrick says that, for primary care practitioners ‘... there is good reason to be sceptical about current diagnostic categories of depression. They are based on shaky foundations, and created within cultural boundaries that will be subject to substantial shifts in the coming decades’. Coinciding with the publication of the 5th edition of the American Psychiatric Association’s DSM-V manual, this issue of the BJGP includes research on aspects of depression. In their systematic review, Shaw and colleagues sound a warning bell about the strength of evidence for the use of structured tools in the assessment and management of depression, and express concerns that sticking to QOF indicators may have unintended adverse consequences. They report that ‘GPs considered the routine use of depression severity structured tools as incentivised by the QOF had a number of unintended consequences, specifically compromising the doctor–patient relationship, threatening holistic practice and intuition, and interfering with the consultation process’. However, it should be added that ‘In contrast, patients were more positive, seeing the tools as efficient and structured supplements to medical judgement, and as evidence that GPs were taking their patients’ problems seriously through full assessment of their depression’.
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