Psychotherapy for depression in primary care: a panel survey of general practitioners’ opinion and prescribing practice

  • Hélène Verdoux
  • Sébastien Cortaredona
  • Hélène Dumesnil
  • Remy Sebbah
  • Pierre Verger
Original Paper

Abstract

Purpose

Psychotherapy is recommended as first-line treatment in patients presenting with mild-to-moderate depression. Although this disorder is mostly managed in primary care, little is known about General Practitioners’ (GPs) practice of prescribing psychotherapy. The objectives were to explore GPs’ opinion on psychotherapy for depression, and the personal and professional characteristics associated with reported strategies for prescribing psychological therapy and/or an antidepressant in mild-to-moderate depression.

Methods

A cross-sectional survey was carried out among participants in a panel of randomly selected GPs (2,114/2,496 participated: 84.7 %). GPs were interviewed using a standardized questionnaire covering their professional and personal characteristics, their practices and opinions in the area of depression management. A multi-model averaging approach was used to explore the characteristics associated with practice of prescribing psychological therapy in mild-to-moderate depression.

Results

Most GPs had a favourable opinion regarding the efficacy of psychotherapy in depression. Slightly more than one out of four reported prescribing psychological therapy alone often/very often in mild-to-moderate depression. These GPs were more likely to be female (OR = 1.56, 95 % CI 1.24; 1.97), to have a personal history of psychotherapy (OR = 1.76, 95 % CI 1.31; 2.38), no history of depression in someone close (OR = 0.80, 95 % CI 0.65; 0.99), and to consider that antidepressants are over-prescribed (OR = 2.02, 95 % CI 1.63; 2.49). No association was found with professional characteristics.

Conclusions

GPs’ personal experience has a greater impact on psychological therapy prescription than professional characteristics. This finding suggests that educational efforts are required for providing GPs decision-making skills regarding psychological therapy prescription, based upon evidence-based medicine rather than subjective factors.

Keywords

Depression Primary care Psychotherapy Antidepressant 

Notes

Acknowledgments

We thank all GPs who participated in the survey as well as the members of the supervisory committee of the French National Panel of Ambulatory General Practices (DRESS; ORS and URPS-ML of Bourgogne, Pays de la Loire, and Provence-Alpes-Côte d’Azur). The authors also thank Ray Cooke for supervising the English of this manuscript.

Conflict of interest

The French Regional Panel of General Practices received funding from the Direction de la Recherche, des Etudes, de l’Evaluation et des Statistiques (DREES)—Ministère du travail, des relations sociales, de la famille, de la solidarité et de la ville/Ministère de la Santé et des Sports as part of the 2010–2012 contract with the Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur; from the Institut de la Recherche en Santé Publique (IReSP), research program 2011’”Santé mentale, prévention, prospective, thématiques générales de l’IReSP”. The authors declare that they have no financial involvement or affiliation with any organisation whose financial interests may be affected by material in this manuscript, or which might potentially bias it.

References

  1. 1.
    Alvidrez J, Arean P (2002) Physician willingness to refer older depressed patients for sychotherapy. Int J Psychiatry Med 32:21–35PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson I, Ferrier I, Baldwin R, Cowen P, Howard L, Lewis G, Matthews K, Lister-Williams R, Peveler R, Scott J, Tylee A (2008) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology Guidelines. J Psychopharmacol 22:343–396PubMedCrossRefGoogle Scholar
  3. 3.
    Andersson SJ, Troein M, Lindberg G (2005) General practitioners’ conceptions about treatment of depression and factors that may influence their practice in this area. A postal survey. BMC Fam Pract 6:21PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Balestrieri M, Williams P, Wilkinson G (1988) Specialist mental health treatment in general practice: a meta-analysis. Psychol Med 18:711–717PubMedCrossRefGoogle Scholar
  5. 5.
    Barrett JE, Williams JW Jr, Oxman TE, Frank E, Katon W, Sullivan M, Hegel MT, Cornell JE, Sengupta AS (2001) Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. J Fam Pract 50:405–412PubMedGoogle Scholar
  6. 6.
    Bech P (2010) Is the antidepressive effect of second-generation antidepressants a myth? Psychol Med 40:181–186PubMedCrossRefGoogle Scholar
  7. 7.
    Boenisch S, Kocalevent RD, Matschinger H, Mergl R, Wimmer-Brunauer C, Tauscher M, Kramer D, Hegerl U, Bramesfeld A (2012) Who receives depression-specific treatment? A secondary data-based analysis of outpatient care received by over 780,000 statutory health-insured individuals diagnosed with depression. Soc Psychiatry Psychiatr Epidemiol 47:475–486PubMedCrossRefGoogle Scholar
  8. 8.
    Bortolotti B, Menchetti M, Bellini F, Montaguti MB, Berardi D (2008) Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials. Gen Hosp Psychiatry 30:293–302PubMedCrossRefGoogle Scholar
  9. 9.
    Briffault X, Sapinho D, Villamaux M, Kovess V (2008) Factors associated with use of psychotherapy. Soc Psychiatry Psychiatr Epidemiol 43:165–171PubMedCrossRefGoogle Scholar
  10. 10.
    Cape J, Barker C, Buszewicz M, Pistrang N (2000) General practitioner psychological management of common emotional problems (I): definitions and literature review. Br J Gen Pract 50:313–318PubMedCentralPubMedGoogle Scholar
  11. 11.
    Cape J, Barker C, Buszewicz M, Pistrang N (2000) General practitioner psychological management of common emotional problems (II): a research agenda for the development of evidence-based practice. Br J Gen Pract 50:396–400PubMedCentralPubMedGoogle Scholar
  12. 12.
    Cuijpers P, Andersson G, Donker T, van Straten A (2011) Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry 65:354–364PubMedCrossRefGoogle Scholar
  13. 13.
    Cuijpers P, Dekker J, Hollon SD, Andersson G (2009) Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis. J Clin Psychiatry 70:1219–1229PubMedCrossRefGoogle Scholar
  14. 14.
    Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G (2010) The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med 40:211–223PubMedCrossRefGoogle Scholar
  15. 15.
    Cuijpers P, van Straten A, van Schaik A, Andersson G (2009) Psychological treatment of depression in primary care: a meta-analysis. Br J Gen Pract 59:e51–e60PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Dowrick C, Gask L, Perry R, Dixon C, Usherwood T (2000) Do general practitioners’ attitudes towards depression predict their clinical behaviour? Psychol Med 30:413–419PubMedCrossRefGoogle Scholar
  17. 17.
    Dumesnil H, Manzi J-M, Apostolidis A, Verger P (2011) Stratégies de prise en charge des troubles anxieux et dépressifs en médecine de ville : une enquête qualitative à Marseille. Observatoire Régional de la Santé Provence-Alpes-Côte d’AzurGoogle Scholar
  18. 18.
    Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J (2010) Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 303:47–53PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Gardarsdottir H, Egberts AC, Heerdink ER (2010) Transitions from General Practitioner to Psychiatrist Care (or vice versa) during a first antidepressant treatment episode. Pharmacopsychiatry 43:179–183PubMedCrossRefGoogle Scholar
  20. 20.
    Glover G, Webb M, Evison F (2010) Improving access to psychological therapies. A review of the progress made by sites in the first rollout year. North East Public Health ObservatoryGoogle Scholar
  21. 21.
    Haddad M, Menchetti M, Walters P, Norton J, Tylee A, Mann A (2012) Clinicians’ attitudes to depression in Europe: a pooled analysis of Depression Attitude Questionnaire findings. Fam Pract 29:121–130PubMedCrossRefGoogle Scholar
  22. 22.
    Harpaz-Rotem I, Libby D, Rosenheck RA (2012) Psychotherapy use in a privately insured population of patients diagnosed with a mental disorder. Soc Psychiatry Psychiatr EpidemiolGoogle Scholar
  23. 23.
    Haute Autorité de Santé (2002) Prise en charge d’un épisode dépressif isolé de l’adulte en ambulatoireGoogle Scholar
  24. 24.
    Himelhoch S, Ehrenreich M (2007) Psychotherapy by primary-care providers: results of a national sample. Psychosomatics 48:325–330PubMedCrossRefGoogle Scholar
  25. 25.
    Institute for clinical systems improvement (2012) Health Care guideline. Major depression in Adults in Primary Care. http://www.icsi.org/depression_5/depression__major__in_adults_in_primary_care_3.html
  26. 26.
    Kass R, Raftery A (1995) Bayes factors. J Am Stat Assoc 90:773–795CrossRefGoogle Scholar
  27. 27.
    Kendrick T, Dowrick C, McBride A, Howe A, Clarke P, Maisey S, Moore M, Smith PW (2009) Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. BMJ 338:b750PubMedCrossRefGoogle Scholar
  28. 28.
    Kessler D, Lewis G, Kaur S, Wiles N, King M, Weich S, Sharp DJ, Araya R, Hollinghurst S, Peters TJ (2009) Therapist-delivered Internet psychotherapy for depression in primary care: a randomised controlled trial. Lancet 374:628–634PubMedCrossRefGoogle Scholar
  29. 29.
    King M, Davidson O, Taylor F, Haines A, Sharp D, Turner R (2002) Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: randomised controlled trial. BMJ 324:947–950PubMedCrossRefGoogle Scholar
  30. 30.
    Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT (2008) Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 5:e45PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Kovess-Masfety V, Alonso J, Brugha TS, Angermeyer MC, Haro JM, Sevilla-Dedieu C (2007) Differences in lifetime use of services for mental health problems in six European countries. Psychiatr Serv 58:213–220PubMedCrossRefGoogle Scholar
  32. 32.
    Kravitz RL, Franks P, Feldman M, Meredith LS, Hinton L, Franz C, Duberstein P, Epstein RM (2006) What drives referral from primary care physicians to mental health specialists? A randomized trial using actors portraying depressive symptoms. J Gen Intern Med 21:584–589PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    National Institute for clinical excellence (2009) National Clinical Practice Guideline 90. Depression: the treatment and management of depression in adults. http://www.nice.org.uk/nicemedia/pdf/Depression_Update_FULL_GUIDELINE.pdf
  34. 34.
    Olfson M, Marcus SC, Druss B, Pincus HA (2002) National trends in the use of outpatient psychotherapy. Am J Psychiatry 159:1914–1920PubMedCrossRefGoogle Scholar
  35. 35.
    Ross S, Moffat K, McConnachie A, Gordon J, Wilson P (1999) Sex and attitude: a randomized vignette study of the management of depression by general practitioners. Br J Gen Pract 49:17–21PubMedCentralPubMedGoogle Scholar
  36. 36.
    Simon GE, Ludman EJ, Rutter CM (2009) Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care. Arch Gen Psychiatry 66:1081–1089PubMedCrossRefGoogle Scholar
  37. 37.
    Simon GE, Von Korff M, Rutter CM, Peterson DA (2001) Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Arch Gen Psychiatry 58:395–401PubMedCrossRefGoogle Scholar
  38. 38.
    Tardieu S, Bottero A, Blin P, Bohbot M, Goni S, Gerard A, Gasquet I (2006) Roles and practices of general practitioners and psychiatrists in management of depression in the community. BMC Fam Pract 7:5PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    van Schaik DJ, Klijn AF, van Hout HP, van Marwijk HW, Beekman AT, de Haan M, van Dyck R (2004) Patients’ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry 26:184–189PubMedCrossRefGoogle Scholar
  40. 40.
    van Schaik DJ, van Marwijk HW, Beekman AT, de Haan M, van Dyck R (2007) Interpersonal psychotherapy (IPT) for late-life depression in general practice: uptake and satisfaction by patients, therapists and physicians. BMC Fam Pract 8:52PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Verdoux H (2007) The current state of adult mental health care in France. Eur Arch Psychiatry Clin Neurosci 257:64–70PubMedCrossRefGoogle Scholar
  42. 42.
    Verdoux H, Cougnard A, Grolleau S, Besson R, Delcroix F (2005) How do general practitioners manage subjects with early schizophrenia and collaborate with mental health professionals? A postal survey in South-Western France. Soc Psychiatry Psychiatr Epidemiol 40:892–898PubMedCrossRefGoogle Scholar
  43. 43.
    Verdoux H, Gaudron Y, Tournier M (2011) Transition in care in persons with antidepressant prescription in naturalistic conditions. Fam Pract 28:400–405PubMedCrossRefGoogle Scholar
  44. 44.
    Verger P, Flicoteau R, Schwarzinger M, Sagaon-Teyssier L, Peretti-Wattel P, Launay O, Sebbah R, Moatti J (2012) Pandemic Influenza (A/H1N1) Vaccine Uptake among French Private General Practitioners: a Cross Sectional Study in 2010. PLoS ONE 7:e41837PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Verhaak PF, van de Lisdonk EH, Bor JH, Hutschemaekers GJ (2000) GPs’ referral to mental health care during the past 25 years. Br J Gen Pract 50:307–308PubMedCentralPubMedGoogle Scholar
  46. 46.
    Viallefont V, Raftery A, Richardson S (2001) Variable selection and Bayesian model averaging in case-control studies. Stat Med 20:3215–3230PubMedCrossRefGoogle Scholar
  47. 47.
    Williams JW Jr, Barrett J, Oxman T, Frank E, Katon W, Sullivan M, Cornell J, Sengupta A (2000) Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. JAMA 284:1519–1526PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Hélène Verdoux
    • 1
    • 2
    • 7
  • Sébastien Cortaredona
    • 3
    • 4
    • 5
  • Hélène Dumesnil
    • 3
    • 4
    • 5
  • Remy Sebbah
    • 6
  • Pierre Verger
    • 3
    • 4
    • 5
  1. 1.University Bordeaux, U657BordeauxFrance
  2. 2.INSERM, U657BordeauxFrance
  3. 3.INSERM, UMR-S912 (SESSTIM)MarseilleFrance
  4. 4.Aix Marseille Université, UMR-S912, IRDMarseilleFrance
  5. 5.ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’AzurMarseilleFrance
  6. 6.Union Régionale des Professionnels de Santé, Médecins Libéraux, PACAMarseilleFrance
  7. 7.Centre Hospitalier Charles PerrensBordeaux CedexFrance

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