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Although some studies have confirmed an association between depression and excessive pain behavior, methodologic problems (such as the use of depression ratings that also recorded symptoms attributable to physical disease) make interpretation of this finding difficult.
A limitation of our study was the use of depression questionnaires instead of diagnostic interviews.
These analyses were adjusted for age and sex and additionally for use of depression or anxiety medication where available.
A study [ 21] of GPs' use of depression screening questionnaires showed that, although doctors used them, they preferred to rely on their 'practical wisdom and clinical judgement'.
Significantly higher use of depression treatment in the IMPACT patients at 18 and 24 months was accounted for entirely by pharmacotherapy.
One study has qualitatively explored GP and patient perspectives of the use of depression severity measures and found that GPs prefer to use their clinical judgement [ 17].
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These studies demonstrated significant methodological heterogeneity (i.e. age range, sex, presence of antidepressant use, method of depression measure, severity of depressive symptoms, duration and study design (RCT vs. cohort)).
In a post hoc analyses using diagnosis of depression or use of an antidepressant medication as an indicator for depression, these patients were evenly distributed in the ulcer-relapse and non ulcer-relapse groups.
21 23–25 Health professionals themselves have expressed dissatisfaction with incentivised depression management, particularly the use of incentivised depression severity measurements, although patients value their use within consultations.
*Adjusted for baseline antidepressant use, severity of depression, level of physical activity, and recruiting centre.
*Adjusted for baseline Beck depression inventory score, antidepressant use, severity of depression, level of physical activity, and recruiting centre.
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