Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alvidrez J, Arean P (2002) Physician willingness to refer older depressed patients for sychotherapy. Int J Psychiatry Med 32:21–35

    Article  PubMed  Google Scholar 

  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 22:343–396

    Article  CAS  PubMed  Google Scholar 

  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 6:21

    Article  PubMed Central  PubMed  Google Scholar 

  4. Balestrieri M, Williams P, Wilkinson G (1988) Specialist mental health treatment in general practice: a meta-analysis. Psychol Med 18:711–717

    Article  CAS  PubMed  Google Scholar 

  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 50:405–412

    CAS  PubMed  Google Scholar 

  6. Bech P (2010) Is the antidepressive effect of second-generation antidepressants a myth? Psychol Med 40:181–186

    Article  CAS  PubMed  Google Scholar 

  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 47:475–486

    Article  PubMed  Google Scholar 

  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 30:293–302

    Article  PubMed  Google Scholar 

  9. Briffault X, Sapinho D, Villamaux M, Kovess V (2008) Factors associated with use of psychotherapy. Soc Psychiatry Psychiatr Epidemiol 43:165–171

    Article  PubMed  Google Scholar 

  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 50:313–318

    CAS  PubMed Central  PubMed  Google Scholar 

  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 50:396–400

    CAS  PubMed Central  PubMed  Google Scholar 

  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 65:354–364

    Article  PubMed  Google Scholar 

  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 70:1219–1229

    Article  PubMed  Google Scholar 

  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 40:211–223

    Article  CAS  PubMed  Google Scholar 

  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–e60

    Article  PubMed Central  PubMed  Google Scholar 

  16. Dowrick C, Gask L, Perry R, Dixon C, Usherwood T (2000) Do general practitioners’ attitudes towards depression predict their clinical behaviour? Psychol Med 30:413–419

    Article  CAS  PubMed  Google Scholar 

  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’Azur

  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 303:47–53

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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 43:179–183

    Article  CAS  PubMed  Google Scholar 

  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 Observatory

  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 29:121–130

    Article  CAS  PubMed  Google Scholar 

  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 Epidemiol

  23. Haute Autorité de Santé (2002) Prise en charge d’un épisode dépressif isolé de l’adulte en ambulatoire

  24. Himelhoch S, Ehrenreich M (2007) Psychotherapy by primary-care providers: results of a national sample. Psychosomatics 48:325–330

    Article  PubMed  Google Scholar 

  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. Kass R, Raftery A (1995) Bayes factors. J Am Stat Assoc 90:773–795

    Article  Google Scholar 

  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:b750

    Article  PubMed  Google Scholar 

  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 374:628–634

    Article  PubMed  Google Scholar 

  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 324:947–950

    Article  PubMed  Google Scholar 

  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:e45

    Article  PubMed Central  PubMed  Google Scholar 

  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 58:213–220

    Article  PubMed  Google Scholar 

  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 21:584–589

    Article  PubMed Central  PubMed  Google Scholar 

  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. Olfson M, Marcus SC, Druss B, Pincus HA (2002) National trends in the use of outpatient psychotherapy. Am J Psychiatry 159:1914–1920

    Article  PubMed  Google Scholar 

  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 49:17–21

    CAS  PubMed Central  PubMed  Google Scholar 

  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 66:1081–1089

    Article  PubMed  Google Scholar 

  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 58:395–401

    Article  CAS  PubMed  Google Scholar 

  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 7:5

    Article  PubMed Central  PubMed  Google Scholar 

  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 26:184–189

    Article  PubMed  Google Scholar 

  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 8:52

    Article  PubMed Central  PubMed  Google Scholar 

  41. Verdoux H (2007) The current state of adult mental health care in France. Eur Arch Psychiatry Clin Neurosci 257:64–70

    Article  PubMed  Google Scholar 

  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 40:892–898

    Article  PubMed  Google Scholar 

  43. Verdoux H, Gaudron Y, Tournier M (2011) Transition in care in persons with antidepressant prescription in naturalistic conditions. Fam Pract 28:400–405

    Article  PubMed  Google Scholar 

  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:e41837

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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 50:307–308

    CAS  PubMed Central  PubMed  Google Scholar 

  46. Viallefont V, Raftery A, Richardson S (2001) Variable selection and Bayesian model averaging in case-control studies. Stat Med 20:3215–3230

    Article  CAS  PubMed  Google Scholar 

  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 284:1519–1526

    Article  CAS  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. University Bordeaux, U657, 33000, Bordeaux, France

    Hélène Verdoux

  2. INSERM, U657, 33000, Bordeaux, France

    Hélène Verdoux

  3. INSERM, UMR-S912 (SESSTIM), 13006, Marseille, France

    Sébastien Cortaredona, Hélène Dumesnil & Pierre Verger

  4. Aix Marseille Université, UMR-S912, IRD, 13006, Marseille, France

    Sébastien Cortaredona, Hélène Dumesnil & Pierre Verger

  5. ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, 13006, Marseille, France

    Sébastien Cortaredona, Hélène Dumesnil & Pierre Verger

  6. Union Régionale des Professionnels de Santé, Médecins Libéraux, PACA, 13006, Marseille, France

    Remy Sebbah

  7. Centre Hospitalier Charles Perrens, 121 rue de la Béchade, 33076, Bordeaux Cedex, France

    Hélène Verdoux

Authors
  1. Hélène Verdoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sébastien Cortaredona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hélène Dumesnil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Remy Sebbah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierre Verger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hélène Verdoux.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Verdoux, H., Cortaredona, S., Dumesnil, H. et al. Psychotherapy for depression in primary care: a panel survey of general practitioners’ opinion and prescribing practice. Soc Psychiatry Psychiatr Epidemiol 49, 59–68 (2014). https://doi.org/10.1007/s00127-013-0717-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0717-8

Keywords

Search

Navigation