Improving primary care for patients with depression

13 Nov 2020

What can be done to enable familiy doctors to detect and treat age-related depressive illness? A novel research and training program has now been approved by the DFG.

As life expectancy continues to rise, the age structure of the population is shifting, and the proportion of elderly individuals is increasing. The downside of this trend is that the fraction of patients with multiple chronic diseases is also growing. This in turn means that the incidence of psychological disorders is increasing – especially that of various forms of depression, which often follow a more complex course in the elderly. Thus, an increased prevalence of depressive illness is seen in patients with type II diabetes, coronary heart disease, obesity, hypertension, and chronic obstructive pulmonary disease (COPD), which affects lung function.

These developments confront family doctors in particular with unfamiliar challenges. As the primary providers of healthcare, they are also the first port of call for patients with multiple disorders (comorbidities), often including depressions. In such cases however, even precise diagnosis is not an easy task. The diverse combinations of symptoms that accompany the various forms of depression make it difficult to distinguish these conditions from one another. Moreover, somatic comorbidities frequently mask the underlying psychological illness. In addition, depressions themselves have an impact on the course of chronic somatic conditions. All of these factors complicate the choice of the most appropriate treatment, quite apart from the potentially negative effects of interactions between specific combinations of drugs. Furthermore, the care of patients with multiple illnesses requires input from various specialists, which can contribute to a fragmentation of care.

In order to redress this situation, physicians based at LMU and the Technical University of Munich (TUM) have now developed a concept for a new Graduate School. Its purpose is to provide new generations of doctors with the know-how needed to deal more effectively with the problems outlined above. The Graduate School is intended to give physicians in training a better, research-based, theoretical understanding of the complex psychosomatic interactions that can occur in patients with multiple disorders. The Deutsche Forschungsgemeinschaft (DFG) will provide 5 million euros in funding for the School over the coming 5 years. The major aim of the medical professionals directly involved in the project on “Predictors and Clinical Indicators of Depressive Disorders in the Context of Primary Care” (the acronym ‘POKAL’ is derived from the original German title) is to enable depressive illnesses in the elderly to be accurately diagnosed and appropriately treated at the earliest possible stage.

Placing special emphasis on the relevant research context, the School’s initiators plan to train three groups, each consisting of 20 young doctors and medical researchers, during the project’s lifetime. The School is principally interested in recruiting candidates from the fields of general medicine, psychology, pharmacology, and the health and nursing sciences. Those who intend to work in primary care can carry out their doctoral research in parallel with their specialist medical training. “The new Graduate School promises to have a substantial and sustained impact – both in Germany and internationally – on research in the field of general medical practice, particularly in the area of psychosomatic and psychiatric care. It‘s also a wonderful example of collaboration between LMU and TUM,” says Professor Antonius Schneider of the Institute for General Medicine and Health Services at the TUM, Co-Director of the Graduate School.

Director Professor Jochen Gensichen of the Institute for General Medicine in the LMU Medical Center, adds: “The Graduate School breaks new ground by combining expertise in general medicine and the fields of psychiatry, psychology, psychosomatic and psychometric medicine with specialized knowledge of data-processing technologies. Its aim is to develop, test and implement new diagnostic procedures and therapeutic options for use in the primary care of patients with depressive disorders.” He goes on to emphasize that participants will receive “state-of-the-art training” and will work on “research problems of immediate relevance to our patients.”

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