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	Institution: STANFORD Univ Med Center  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 9 No. 2, February 2000   Archives  •  Online Features Original Contribution  This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (119)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal The Role of Competing Demands in the Treatment Provided Primary Care Patients With Major Depression Kathryn Rost, PhD; Paul Nutting, MD; Jeffrey Smith, BS; James C. Coyne, PhD; Lisa Cooper-Patrick, MD; Lisa Rubenstein, MD Arch Fam Med. 2000;9:150-154. Objective  To examine whether competing demands explain the appearance of inadequate primary care depression treatment observed at a single visit. Design  A cross-sectional patient survey. Participants and Setting  Two hundred forty patients with 5 or more symptoms of depression seeing 12 physicians in 6 primary care practices, representing 77.4% of the depressed patients identified through 2-stage screening of more than 11,000 primary care attenders. Main Outcome Measures  In patients with elevated depressive symptoms, discussing depression as a possible diagnosis in untreated patients, and changing depression management in treated patients. Results  Physicians and patients discussed depression in 46 (47.9%) of 96 untreated patients; physicians changed depression treatment recommendations in 87 (60.4%) of 144 treated patients with current symptoms. Chronic physical comorbidity decreased the odds that physicians and untreated patients discussed depression as a possible diagnosis (odds ratio = 0.66, P = .01). New problems decreased the odds that treatment recommendations would be changed in treated patients who remained depressed (odds ratio = 0.39, P = .05). Physicians and untreated patients were more likely to discuss depression as a possible diagnosis if patients reported antidepressant medication was acceptable (odds ratio = 4.57, P = .01) and less likely to discuss depression if patients reported specialty care counseling was acceptable (odds ratio = 0.33, P = .05). Conclusions  The attention depression gets during a given medical visit is less associated with the severity of the patient's depressive symptoms than with the number or recency of other problems the patient has. If competing demands provide ongoing barriers to depression treatment, interventions will be needed to assure that patients with chronic physical problems receive high-quality mental health care in the primary care setting. From the Centers for Mental Healthcare Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Dr Rost and Mr Smith); Ambulatory Sentinel Practice Network, Denver, Colo (Dr Nutting); Department of Family Medicine, University of Michigan, Ann Arbor (Dr Coyne); Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md (Dr Cooper-Patrick); and Sepulveda Veterans Administration, Sepulveda, Calif, RAND, Santa Monica, Calif, and University of California at Los Angeles (Dr Rubenstein). RELATED ARTICLE The Archives of Family Medicine Continuing Medical Education Program Arch Fam Med. 2000;9(2):175-177. FULL TEXT   THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Does Diabetes Double the Risk of Depression? O'Connor et al. Ann Fam Med 2009;7:328-335. ABSTRACT | FULL TEXT   Will Hypertension Performance Measures Used for Pay-for-Performance Programs Penalize Those Who Care for Medically Complex Patients? Petersen et al. 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