Commentary

This systematic review by Gilbody et al documents no effect of providing clinicians with the results of routinely administered questionnaires for depression and anxiety among unselected patients in non-psychiatric settings, such as primary care or hospital outpatient clinics. However, there appears to be a clinical effect of feedback alone in improving the recognition of psychiatric disorders among high risk patients in non-psychiatric settings. As one might expect from a perspective of behaviour change theory,¹ information, although necessary, is alone insufficient to substantially change management or outcomes. As Gilbody et al have discussed, more complex strategies in which feedback is accompanied by increased resources (eg, an outside referral agency that administers and scores the questionnaire) and educational interventions can result in improved outcome for depression.

The results are applicable to nurses who practice in non-psychiatric settings in the community or in general hospitals. The findings support the renewed emphasis on mental health practice by generalist nurses. Mental health care in primary healthcare settings is a practice that is unemphasised by nurses and other clinicians, yet is a main contributor to expenditures for resources consumed by those with chronic physical illnesses.² Evidence shows that investing in additional resources for psychosocial care in outpatient clinics for physical illness,³ and in primary care is both more effective and less expensive.⁴ Psychosocial care pays for itself with reductions in the use of other insured resources.