The identification and treatment of depression by General Practitioners

Objective: To assess the level of recognition and knowledge about treatment of depression by General Practitioners (GPs). Method: Analysis of questionnaires completed by participants commencing a series of workshops aimed at improving their knowledge of the diagnosis and treatment of depression. Of the 3289 GPs involved in the program 2500 (76% respondent rate) completed the questionnaires in a group situation. There was no difference between respondents and non-respondents in terms of age, gender and year of graduation. Results: The majority of GPs believe they have a satisfactory competence in the recognition and treatment of depression, although a sizeable minority based their diagnosis predominantly on somatic symptoms. The GPs felt confident about their knowledge and skills in counselling and the use of antidepressant medication, but not in dealing with children and suicidal or pregnant patients. The most common symptoms used to identify 'depression' were sleep disorders and only 54% listed depressed mood as a symptom on which the diagnosis is based. Only 28% reported sufficient symptoms to meet criteria for DSM-IV major depressive disorder, which supports views that these criteria are inappropriate for general practice. Fifty-seven percent of doctors used medicine together with nonpharmacological treatment in the majority of patients, and medications doses were almost all within the range recommended in the product information. Conclusions: There is a need to improve GPs knowledge in diagnosing depression, in child psychiatry and in dealing with pregnant and suicidal patients.