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A comparison of outcomes of patients with depression, recurrent depression, and depression and anxiety within patients in a British CMHT.

INTRODUCTION
Many patients in Community Mental Health Teams have a diagnosis of depression F32, recurrent depression F33, and depression and anxiety F41.2, and such patients are often considered by team managers as being suitable for discharge to primary care. It is necessary to describe factors that influence outcomes, specifically discharge, in order to identify suitable patients who might continue their treatment in primary care. We aimed to assess the influence of suicidality, alcohol and drug abuse and augmentation strategies on the discharge status of patients treated by the Bedford East Community Mental Health Team (BECMHT) who have been diagnosed with depression in each of the three groups F32, F33, and F41.2.


SUBJECTS AND METHODS
Using the team database, we identified 168 patients with depression F32, recurrent depressive disorder F33 and depression and anxiety F41.2. We then established their discharge status (discharged, enhanced CPA and normal CPA) and identified factors that may influence the discharge status (suicidal ideation, alcohol and drug problems and augmentation therapy). Outcome as measured by patient discharge and the prevalence of each factor was compared in the three groups.


RESULTS
The group who had been diagnosed with a depressive episode, F32 , were less likely to be discharged and appeared to be more likely to suffer from alcoholism, illicit drug abuse, and suicidality.


DISCUSSION
Arguably, the F32 group could be a more heterogeneous group of patients, F32 becoming a 'default diagnosis' into which both patients with a discrete 'depressive episode' and patients with a 'depressive episode plus other problematic factors' were put, while the F33 and F42.1 groups were more clear cut.


CONCLUSION
Suicidality, alcoholism, and illicit drug use clearly impact on the outcomes of patients in the diagnostic groups studied.