More Primary Care Physicians Now Treating Depression

January 14, 1999

Most primary care physicians are confident in their ability to diagnose depression and endorse this important role as part of their clinical responsibilities, according to a national survey of family physicians, general internists, and obstetrician-gynecologists.

In addition, many are providing treatment "consistent with guidelines for high quality care," says John W. Williams, Jr., M.D., of the South Texas Veterans Health Care System, San Antonio, and colleagues writing in the January-February issue of Archives of Family Medicine.

The failure to recognize and treat depression in primary care has been repeatedly criticized in scientific research. It is estimated that depression afflicts 15 percent or more of those who seek help from primary care physicians, compared to an estimated 2-6 percent in the general population. Also, depressed patients use health care services three times more often than non-depressed patients, leading to concerns that depression in many patients was going undetected.

"Primary care physicians appear to be doing better in this area than the critics suggest," comments co-author Allen J. Dietrich, M.D., of Dartmouth Medical School .

The research team asked 1,350 primary care physicians nationwide how they treated their patient most recently diagnosed with major depression, minor depression, or "dysthymia," a less serious condition marked by chronically depressed mood. More than 90 percent were confident in their ability to diagnose depression.

"While treatment appears to be getting better," Williams says, "there remains plenty of room for improvement.

"For example, it is recommended that physicians ask directly about suicidal feelings, and schedule follow-up visits within two weeks, but in our survey they asked about suicidal feelings infrequently and only scheduled two-week follow-ups about half the time."

Among the 621 family physicians surveyed, 88 percent viewed depression treatment as part of the clinical role, compared with 73 percent of the 464 general internists and 41 percent of the 255 obstetrician-gynecologists questioned. Similarly, 83 percent of family physicians were mostly confident or very confident in their ability to treat depression; 64 percent of general internists, and 34 percent of obstetrician-gynecologists expressed the same degree of confidence.

"The specialty differences most likely reflect differences in specialty training for depression," Williams and colleagues write. While family-practice training programs have long emphasized the biological, psychological, and social aspects of health, training in internal medicine and gynecology has incorporated these aspects relatively recently.

"Obstetrician-gynecologists, who have only recently come into their role as primary care providers, are an important source of primary care for women of childbearing age, a group at high risk for depression," Williams says. "They've had less training in depression diagnosis and treatment, and this is reflected by less confidence and greater perceived barriers to care."

While changes in training take time to diffuse into medical practice, it appears that many obstetrician-gynecologists are ready to adopt their new role, Williams and colleagues say. More than half (55 percent) of obstetrician-gynecologists who expressed a lack of confidence in their depression care said they planned to change their treatment practices.

The investigators are collaborating with representatives from the three specialty societies to further enhance physicians' skills through an interactive training program on depression specifically designed for primary care physicians. The research was supported by a grant from the John D. and Catherine T. MacArthur Foundation.

Archives of Family Medicine is published by the American Medical Association.

Posted by the Center for the Advancement of Health For information about the Center contact Richard Hebert, 202-387-2829.

Center for Advancing Health

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