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