Literature Collection

OBJECTIVES: Depressive disorders are common in the primary care setting. Despite its high prevalence, depression treatment in primary care is less guideline-oriented compared to specialized settings, which often makes it less efficient. Current research has focused on explanations on the practitioner's side but has neglected the patient's perspective and its effect on treatment largely. METHODS: We conducted a scoping review on the electronic databases Medline and Psycinfo. Eligible publications contained information of the patients' perspective on depression treatment in primary care in OECD member states. Publications until August 2nd 2023 were considered. RESULTS: After the removal of duplicates, the search yielded 14.059 articles, of which 232 were included. Current literature focuses on behavioral and obvious measures like satisfaction, and on patient-sided barriers and facilitators to adherence. Other treatment-related behaviors are less researched. Patients with undiagnosed depression often report exclusively or mainly physical symptoms in general practice. CONCLUSION: This review provides a comprehensive framework for the concept. Research on barriers and facilitators to depression treatment in primary care is still inconclusive. Educating patients and addressing stigmatizing beliefs are promising targets to promote the seeking out, initiation of, and adherence to treatment. Being aware of a hidden depression when somatic symptoms are present, can help to detect more cases. REGISTRATION: This review is registered via OSF (https://osf.io/p9rnc).

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a major advancement in obesity treatment, offering robust efficacy in weight loss and metabolic regulation. Beyond these effects, emerging evidence indicates that GLP-1 RAs also modulate appetite, reward sensitivity, and self-regulation, domains that intersect with behavioral and psychological functioning. This review adopts a biopsychosocial perspective to examine how GLP-1 RAs interact with eating behavior, mood, identity, and self-regulation, particularly in individuals with binge eating disorder (BED) or other psychiatric comorbidities. A clinical framework is proposed to integrate pharmacotherapy with lifestyle and psychological interventions. The temporary reduction in appetite and food reward may create a "low-drive window" in which behavioral strategies such as self-monitoring or stimulus control become more effective. However, high emotional eating, mood symptoms, or identity conflicts may moderate treatment response. Given the high prevalence of psychiatric comorbidities, structured screening using tools like the Patient Health Questionnaire-9 (PHQ-9) or Binge Eating Scale (BES) is recommended. A stepped-care approach from brief digital interventions to formal psychotherapy may help address varying support needs. Crucially, weight regain after discontinuation is common. The review discusses behavioral, psychological, and social mechanisms of relapse and highlights strategies for long-term stabilization. These include emotion regulation, body image work, and maintenance-focused behavioral interventions. GLP-1 RAs should therefore be seen not as standalone treatments but as facilitators of self-directed, sustainable change within integrated care models. Future research should define composite outcomes, explore digital tools for relapse prevention, and develop adaptive pathways tailored to individual psychological profiles.

As Canadian healthcare moves toward integrated care, it lacks "North Star" metrics, relying instead on hospital-centric indicators that miss the patient experience. Building on the integrated care framework by Anne Wojtak and Jodeme Goldhar, this paper argues for shifting from measuring system activity to measuring the burden placed on patients and caregivers. It proposes three new metrics: the System Friction Ratio, the Caregiver Latency Index and the Patient-Reported Burden Score. To achieve true population health, we must stop counting hospital-focused administrative outputs and start measuring the friction patients and families face when navigating the system.