Objectives To identify the lowest sensitivity and specificity that physicians and the general population consider acceptable for medical artificial intelligence (AI), relative to current human performance. Methods In a nationwide, cross-sectional survey in Sweden, 2025, random samples of 500 physicians and 500 adults from the general population were mailed a questionnaire presenting three vignettes (chest pain triage, sore throat triage, ECG myocardial infarction detection) with the corresponding human performance. Participants reported the maximum number of cases an AI should be allowed to miss or over-refer. Results Response rates were 45% among physicians and 31% in the general population. Both groups demanded higher AI accuracy than the human benchmark for all cases. In the chest pain triage vignette, the nurse correctly referred 84 of 100 true emergencies; physicians required the AI to correctly refer 11 additional patients (95% sensitivity) and the general population demanded referral of 16 additional patients (100% sensitivity) (p<0.001 for both groups). Among 100 patients not requiring referral, the nurse would mistakenly refer 66. Both groups required the AI to reduce unnecessary referrals by 16 (50% specificity) (p<0.001). A similar pattern was observed in the other vignettes. Discussion The accuracy thresholds required by the respondents exceed the performance of many existing systems, although emerging AI research shows promise in narrowing the gap. Conclusion Physicians and the general population require medical AI systems to outperform human clinicians. When implementing AI in healthcare settings, early engagement with both groups may be necessary to align expectations with real-world system performance.

Background Depression in adolescence is a significant global health concern, notably in Sweden where recent trends suggest an increase in depressive symptoms among adolescents. This study aims to explore changes in the prevalence of self-reported depressive symptoms among Swedish high school students over the past two decades, utilizing the Children's Depression Inventory (CDI). Method A cohort study was conducted with two adolescent groups aged 13-16 years old, born nearly twenty years apart. The first cohort (n=80), recruited in 2004, and the second (n=617), recruited between 2019 and 2020, were both assessed using the CDI. The study employed a comparative analysis, using independent samples t-tests, ANOVA, and the Mann-Whitney U test for item-specific comparisons. Results The analysis revealed no significant differences in total CDI scores between the 2004 and 2019/20 cohorts. However, the later cohort exhibited higher scores on three CDI items ("Nothing is fun at all," "I am bad all the time," "I can never be as good as other kids") and in the sub-domain of self-deprecation. Sex differences were observed, with girls scoring higher than boys in both cohorts. Conclusion There is no statistically significant increase in self-assessed levels of depressive symptoms among adolescents when comparing the 2004 and 2019-20 cohorts. However, there are higher scores in specific areas of the CDI in the later cohort, particularly among young women. This study underscores the need for continuous, structured assessments of adolescent mental health, considering societal changes and trends.

Background:The introduction of artificial intelligence (AI) in health care holds great promise, offering the potential to alleviate physicians' workloads and allocate more time for patient interactions. After the emergence of large language models (LLMs), interest in AI has surged in the health care sector, including within primary care. However, patients have expressed concerns about the ethical implications and use of AI in primary care. Understanding patients' perspectives on using AI in primary care is crucial for its effective integration. Despite this, few studies have addressed patients' perspectives on using AI in primary care. Objective:This study aimed to synthesize qualitative research on primary care patients' perspectives regarding the use of AI, including LLMs, in primary care. Methods:A qualitative systematic review, using thematic analysis, was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Databases, including PubMed, Scopus, Web of Science, CINAHL, and PsycINFO, were searched from inception to February 5, 2024. Eligible studies (1) used a qualitative interview research design, (2) explored primary care patients' perspectives on the use of AI in primary care, (3) were written in English, and (4) were published in peer-reviewed scientific journals. Quantitative studies, gray literature, surveys, and studies lacking depth in qualitative analysis were excluded. The Critical Appraisal Skills Program (CASP) checklist was used for quality assessment. Results:Of 1004 studies screened, 6 were included, comprising 170 patients aged 13-91 years from 3 countries. Three themes emerged: "The Relationship with and Actions of AI Systems," "Implementing AI responsibly," and "Training Physicians and Artificial Minds." Patients acknowledged AI's potential benefits but advocated for clinician oversight, safety frameworks, and the preservation of patient autonomy. Conclusions:This systematic review provides an understanding of patients' perspectives on AI in primary care. We identified heterogeneity in AI definitions across studies. Further research is needed on patients' perspectives across different countries. Notably, our synthesis revealed a significant research gap, as none of the included studies particularly explored patients' perspectives on LLMs, highlighting an important area for future research.

Introduction Primary care centers (PCCs) are the foundation of healthcare, requiring a supportive work environment for quality care and personnel well-being. To address rising common mental disorders (depression, anxiety, stress-related disorders) care managers were introduced in Region Västra Götaland in 2015 and are now established in 175 PCCs, supported by clinical and economic benefits. This study explores changes in the organisational and social work environment experienced by PCC personnel five years post-implementation of care managers at two points: 2016/17 and 2021/22.Materials and methods This repeated cross-sectional study was conducted as an open cohort at 36 strategically selected PCCs in 2016/17 and 2021/22. Although the personnel varied, consistent instruments were used. Descriptive statistics and cross-tabulations examined differences in the organizational and social work environment at the two periods.Trial registration NCT02378272, 2015-02-02. Retrospectively registered.Results Familiarity with the care manager function increased from 72% in 2016/17 to 79% in 2021/22. Motivation to collaborate increased by 80%, reflecting a 62% higher willingness compared to 2016/17. Personnel’s knowledge and motivation were significantly associated with perceived improvements in the work environment. These improvements were consistent across gender, age, PCC size, and geographic location. Personnel at smaller PCCs reporting slightly greater improvements, with some age-related variation.Conclusions Having a care manager on site may have limited direct impact on individual work or perceptions of the work environment. However, increased knowledge of the function appears to strengthen collaboration collegial support within the PCC, indicating positive changes in the social and organisational work environment.

ObjectivesTo investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact.DesignPragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level.SettingPCCs in Region Vastra Gotaland, Sweden, with care manager organisation.ParticipantsOf 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder (n = 142 intervention, n = 116 control PCCs).InterventionCooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3 months. Regular contact with care manager was continued at the control PCCs.Main outcome measures12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12 months.ResultsThere were no significant differences between intervention and control groups after 12 months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7 days (95% confidence interval (CI) 82.6 - 138.8); control, mean = 99.1 days (95% CI 73.9 - 124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12 months. At 3 months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6 months 38% vs 32.8%, and12 months 16.9% vs 15.5%.ConclusionIncreased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation.Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017ConclusionIncreased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation.Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017ConclusionIncreased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation.Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017ConclusionIncreased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation. Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017

AIM:The aim of this study was to investigate a cohort of Swedish eighth graders' mental health and experiences during the COVID-19 pandemic.METHODS:Participants were 157 eighth graders recruited in junior high schools during 2020 who completed a depression questionnaire and a survey about their psychosocial health in relation to the COVID-19 pandemic, alongside a follow-up assessment in 2021. Analyses were conducted using latent change score and cross-lagged models.RESULTS:Participants' depressive symptoms did not substantially increase during the COVID-19 pandemic. The level of depressive symptoms in 2020 was significantly associated with participants' perceptions of the pandemic in 2020 and spring 2021. Participants with higher depression scores reported worse experiences of the pandemic.CONCLUSIONS:The stable level of depressive symptoms among this cohort of eighth graders suggested that keeping schools open during a nationwide lockdown could mitigate some mental health consequences. Adolescents in this study with higher self-assessed depressive symptoms were more likely to experience increased depression after 6 months and had worse experiences during the pandemic than others. This suggests that the pandemic may not immediately affect mental well-being, but those at risk may be affected over time.

Objective:To evaluate if a brief educational intervention for primary health care staff regarding endometriosis gives sustainable knowledge of endometriosis symptoms and if a brief questionnaire for women seeking care for common symptoms is feasible in the Swedish primary care context.Design:Pilot study.Setting:3 primary care centres (PCCs) in Sweden. Exploring knowledge among staff about endometriosis at baseline and 3 months after an information workshop. Evaluation of feasibility of a brief questionnaire for women seeking care for common symptoms For PCC personnel: knowledge about endometriosis at baseline and after 3 months. For patient questionnaire: whether adequate, understandable, acceptable, and feasible.Participants:Females in primary care centre waiting room, and staff members at participating PCCs.Results:The knowledge level of endometriosis was improved or sustained after 3 months compared to baseline among staff at PCCs. Over 90% of the patients stated that the questionnaire was adequate, understandable, acceptable, and feasible.Conclusion:We found that an educational programme improved the staff's knowledge about endometriosis. The programme together with the patient questionnaire could be a way to enhance knowledge about endometriosis among PCCs. This combined effort might facilitate earlier detection and treatment of women with endometriosis.

Context: Endometriosis is an estrogen-dependent, benign, chronic inflammatory disease, characterised by endometrial-like tissue outside of the uterus. Due to diagnostic difficulties, women with endometriosis usually have symptoms for many years (6-12 years) before receiving a diagnosis Objective: To evaluate if a brief educational intervention for primary health care staff regarding endometriosis gives sustainable knowledge of endometriosis symptoms and if a brief questionnaire for women seeking care for common symptoms is feasible in the Swedish primary care context. Study Design and Analysis: Pilot study exploring knowledge among staff about endometriosis at baseline and 3 months after an information workshop at 3 primary care centres (PCCs). Evaluation of feasibility of a brief questionnaire for women seeking care for common symptoms For PCC personnel: knowledge about endometriosis at baseline and after 3 months. For patient questionnaire: whether adequate, understandable, acceptable, and feasible. Standard statistical methods were used for descriptive statistics. Continuous variables were analysed by independent-samples t-test and categorical variables or frequencies by Pearson chi-square test. Setting: Three rural Primary care centres in Sweden Population: Primary care centre staff, and women aged between 18-65 in primary care waiting rooms. Intervention/Instrument: A brief educational lecture to staff members. Questionnaire about common symptoms and feasibility of the questionnaire itself. Outcome measure: Questionnaire for staff members at baseline and after 3 months. Patient questionnaire and patients’ perceptions of patient questionnaire at baseline. Results: Staff members at baseline (n=43) and staff members at 3 months (n=55). Further, female patients (n=106) aged 13-58 in the primary care centre waiting room. The knowledge level of endometriosis was improved or sustained after 3 months compared to baseline among staff at PCCs. Over 90% of the patients stated that the questionnaire was adequate, understandable, acceptable, and feasible. Conclusion: We found that an educational programme improved the staff’s knowledge about endometriosis. The programme together with the patient questionnaire could be a way to enhance knowledge about endometriosis among PCCs. This combined effort might facilitate earlier detection and treatment of women with endometriosis.

OBJECTIVES:To study whether early and enhanced cooperation within the primary care centres (PCC) combined with workplace cooperation via a person-centred employer dialogue meeting can reduce days on sick leave compared with usual care manager contact for patients on sick leave because of common mental disorders (CMD). Secondary aim: to study lapse of CMD symptoms, perceived Work Ability Index (WAI) and quality of life (QoL) during 12 months. DESIGN:Pragmatic cluster randomised controlled trial, randomisation at PCC level. SETTING:28 PCCs in Region Västra Götaland, Sweden, with care manager organisation. PARTICIPANTS:30 PCCs were invited, 28 (93%) accepted invitation (14 intervention, 14 control) and recruited 341 patients newly sick-listed because of CMD (n=185 at intervention, n=156 at control PCCs). INTERVENTION:Complex intervention consisting of (1) early cooperation among general practitioner (GP), care manager and a rehabilitation coordinator, plus (2) a person-centred dialogue meeting between patient and employer within 3 months. CONTROL GROUP:regular contact with care manager. MAIN OUTCOME MEASURES:12 months net and gross number of sick leave days at group level. SECONDARY OUTCOMES:12 months depression, anxiety, stress symptoms, perceived WAI and QoL (EuroQoL-5 Dimensional, EQ-5D). RESULTS:No significant differences were found between intervention and control groups concerning days of sick leave (intervention net days of sick leave mean 102.48 (SE 13.76) vs control 96.29 (SE 12.38) p=0.73), return to work (HR 0.881, 95% CI 0.688 to 1.128), or CMD symptoms, WAI or EQ-5D after 12 months. CONCLUSIONS:It is not possible to speed up CMD patients' return to work or to reduce sick leave time by early and enhanced coordination among GP, care manager and a rehabilitation coordinator, combined with early workplace contact over and above what 'usual' care manager contact during 3 months provides. TRIAL REGISTRATION NUMBER:NCT03250026.

Abstract Objectives: To evaluate if a brief educational intervention for primary health care staff regarding endometriosis gives sustainable knowledge of endometriosis symptoms and if a brief questionnaire for women seeking care for common symptoms is feasible in the Swedish primary care context. Design: Pilot study Setting: 3 primary care centres (PCCs) in Sweden. Exploring knowledge among staff about endometriosis at baseline and 3 months after an information workshop. Evaluation of feasibility of a brief questionnaire for women seeking care for common symptoms For PCC personnel: knowledge about endometriosis at baseline and after 3 months. For patient questionnaire: whether adequate, understandable, acceptable, and feasible. Participants: Females in primary care centre waiting room, and staff members at participating PCCs. Results: The knowledge level of endometriosis was improved or sustained after 3 months compared to baseline among staff at PCCs. Over 90% of the patients stated that the questionnaire was adequate, understandable, acceptable, and feasible. Conclusion: We found that an educational programme improved the staff’s knowledge about endometriosis. The programme together with the patient questionnaire could be a way to enhance knowledge about endometriosis among PCCs. This combined effort might facilitate earlier detection and treatment of women with endometriosis.

Abstract Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls. Trial registration ClinicalTrials.gov identifier: NCT02378272. Submitted 2/2/2015. Posted 4/3/2015.

Introduction Mental illness is a growing problem among adolescents. Adolescents are sensitive and at increased risk of developing a first depression. There are knowledge gaps about the long-term effects of prevention programs against depresson for adolescents.ObjectivesA randomized controlled study among Swedish adolescents in eighth grade, who are at risk of developing depression. The study examines the long-term effects of the “Thoughts and Health” prevention program and whether it is as effective Online as In Real Life (IRL).MethodsIn a first step, about 20 junior high schools in the Västra Götaland region will be recruited and randomised into one of three groups.The adolescents are screened for depression at schoolGroup 1 - Adolescents at risk of developing depression receive the course program “Thoughts and Health” Online.Group 2 - Adolescents at risk of developing depression receive the course program “Thoughts and Health” IRL.Group 3 - Adolescents at risk of developing depression receive the usual school health care (control group).Psychologists decide inclusion after a diagnostic interview. OUTCOME VARIABLESQuantitative- development of depression is measured via self-assessment instruments and follow-up assessment, by a psychologist.- school attendance and full grades at the end of compulsory school.- biomarkersQualitativeAdolescent’s experiences and perceptions of the course program.ResultsWill create evidence for prevention programs against depression and be used to develop primary prevention for adolescents Online and IRL, which will be of great importance to public health.ConclusionsThoughts and Health can be a useful tool to prevent depression among adolescentsDisclosureNo significant relationships.

Background In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers’ and rehabilitation coordinators’ perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting. Methods From an ongoing RCT with 20 primary care centres, care managers (CMs) ( n = 13) and rehabilitation coordinators (RCs) ( n = 12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud. Results Seven codes describing the participants’ experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process. Conclusion The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient’s situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient. Trial registration NCT03250026 (registered August 15, 2017).

OBJECTIVE:To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.DESIGN:Cost-effectiveness analysis.SETTING:23 PCCs in two Swedish regions.PARTICIPANTS:Patients with depression (n=342).MAIN OUTCOME MEASURES:A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.RESULTS:Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.DISCUSSION:The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.TRIAL REGISTRATION NUMBER:NCT02378272; Results.

BACKGROUND: Depression reduces individuals' function and work ability and is associated with both frequent and long-term sickness absence. OBJECTIVE: Investigate if monitoring of depression course using a self-assessment instrument in recurrent general practitioner (GP) consultations leads to improved work ability, decreased job strain, and quality of life among primary care patients. METHODS: Primary care patients n = 183, who worked. In addition to regular treatment (control group), intervention patients received evaluation and monitoring and used the MADRS-S depression scale during GP visit at baseline and at visits 4, 8, and 12 weeks. Work ability, quality of life and job strain were outcome measures. RESULTS: Depression symptoms decreased in all patients. Significantly steeper increase of WAI at 3 months in the intervention group. Social support was perceived high in a significantly higher frequency in intervention group compared to control group. CONCLUSIONS: Monitoring of depression course using a self-assessment instrument in recurrent GP consultations seems to lead to improved self-assessed work ability and increased high social support, but not to reduced job strain or increased quality of life compared to TAU. Future studies concerning rehabilitative efforts that seek to influence work ability probably also should include more active interventions at the workplace.

Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden.

Objective: The objective of this study was to explore primary care patients' experiences of Internet mediated cognitive behavioural therapy (iCBT) depression treatment. Design: Qualitative study. Data were collected from focus group discussions and individual interviews. Setting: Primary care. Method: Data were analysed by systematic text condensation by Malterud. Subjects: Thirteen patients having received iCBT for depression within the PRIM-NET study. Main outcome measures: Analysis presented different aspects of patients' experiences of iCBT. Results: The informants described a need for face-to-face meetings with a therapist. A therapist who performed check-ups and supported the iCBT process seemed important. iCBT implies that a responsibility for the treatment is taken by the patient, and some patients felt left alone, while others felt well and secure. This was a way to work in privacy and freedom with a smoothly working technology although there was a lack of confidence and a feeling of risk regarding iCBT. Conclusion: iCBT is an attractive alternative to some patients with depression in primary care, but not to all. An individual treatment design seems to be preferred, and elements of iCBT could be included as a complement when treating depression in primary care. Such a procedure could relieve the overall treatment burden of depression.

Little information is available about whether the use of self-assessment instruments in primary care affects depression course and outcome. The purpose was to evaluate whether using a depression self-rating scale in recurrent person-centred GP consultations affected depression severity, quality of life, medication use, and sick leave frequency.

Objective: The aim of the current study was to better understand how patients with depression perceive the use of MADRS-S in primary care consultations with GPs.Design: Qualitative study. Focus group discussion and analysis through Systematic Text Condensation.Setting: Primary Health Care, Region Västra Götaland, Sweden.Subjects: Nine patients with mild/moderate depression who participated in a RCT evaluating the effects of regular use of the Montgomery-Åsberg Depression Self-assessment scale (MADRS-S) during the GP consultations.Main Outcome measure: Patients' experiences and perceptions of the use of MADRS-S in primary care.Results: Three categories emerged from the analysis: (I) confirmation; MADRS-S shows that I have depression and how serious it is, (II) centeredness; the most important thing is for the GP to listen to and take me seriously and (III) clarification; MADRS-S helps me understand why I need treatment for depression.Conclusion: Use of MADRS-S was perceived as a confirmation for the patients that they had depression and how serious it was. MADRS-S showed the patients something black on white that describes and confirms the diagnosis. The informants emphasized the importance of patient-centeredness; of being listened to and to be taken seriously during the consultation. Use of self-assessment scales such as MADRS-S could find its place, but needs to adjust to the multifaceted environment that primary care provides.Key PointsPatients with depression in primary care perceive that the use of a self-assessment scale in the consultation purposefully can contribute in several ways. The scale contributes toConfirmation: MADRS-S shows that I have depression and how serious it is.Centeredness: The most important thing is for the GP to listen to and take me seriously.Clarification: MADRS-S helps me understand why I need treatment for depression.