Barriers to the effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice. Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients. Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p=0.00), as did female GPs (p=0.00). Male GPs (p=0.00) and those in rural settings (p=0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p=0.00). Urban-based GPs (p=0.04) and those with prior mental health training (p=0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p=0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p=0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p=0.01), although the results were not entirely consistent. Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.