Beliefs and Attitudes of French Family Practitioners toward Depression: The Impact of Training in Mental Health

Abstract

Objective:

To study, in a sample of French Family Practitioners (FPs), beliefs and attitudes toward depression and how they vary according to training received in mental health.

Methods:

The Depression Attitude Questionnaire (DAQ) was completed by 468 FPs from all regions of France, recruited by pharmaceutical company representatives to attend focus groups on the management of depression in general practice.

Results:

A three-factor model was derived from the DAQ, accounting for 37.7% of the total variance. The correlations between individual items of each component varied from 0.4 to 0.65, with an overall internal consistency of 0.47 (Cronbach's alpha). FPs had an overall neutral position on component 1, professional ease, a positive view on the origins of depression and its amenability to change (component 2), and a belief in the necessity of medication and the benefit of antidepressant therapy (component 3). Training in mental health, specifically through continuing medical education and postgraduate psychiatric hospital training, was significantly and positively associated with both professional ease and a medication approach to treating depression.

Conclusion:

This study is the first description of the beliefs and attitudes of French FPs toward depression using a standardized measure, the DAQ, despite the instrument's limited psychometric properties. It shows the positive effect of training in mental health on attitudes toward depression.

Keywords

depression attitudes family physicians training in mental health

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References

Cooper

Brown

. Primary care patients' opinions regarding the importance of various aspects of care for depression. General Hospital Psychiatry 2000; 22: 163–173.

Link

Struening

Neese-Todd

. Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services 2001; 52: 1621–1626.

Marks

Goldberg

Hillier

. Determinants of the ability of general practitioners to detect psychiatric illness. Psychology and Medicine 1979; 9: 337–353.

Ormel

Giel

. Medical effects of nonrecognition of affective disorders in primary care. In: Sartorius

Goldberg

de Girolamo

, Psychological disorders in general medical settings. Toronto, Hogrefe & Huber Publishers on behalf of the WHO, 1990.

Richards

Ryan

McCabe

. Barriers to the effective management of depression in general practice. Australia and New Zealand Journal of Psychiatry 2004; 38: 795–803.

Koenig

. Physician attitudes toward treatment of depression in older medical inpatients. Aging Mental Health 2007; 11: 197–204.

Weich

Morgan

King

Nazareth

. Attitudes to depression and its treatment in primary care. Psychology and Medicine 2007; 37: 1239–1248.

Araya

Lewis

Rojas

Mann

. “Patient knows best”—Detection of common mental disorders in Santiago, Chile: Cross sectional study. British Medical Journal 2001; 322: 79–81.

Maginn

Boardman

Craig

. The detection of psychological problems by General Practitioners—Influence of ethnicity and other demographic variables. Social Psychiatry and Psychiatric Epidemiology 2004; 39: 464–471.

10.

Rosenberg

Lussier

Beaudoin

. Determinants of the diagnosis of psychological problems by primary care physicians in patients with normal GHQ-28 scores. General Hospital Psychiatry 2002; 24: 322–327.

11.

Tylee

Jones

. Managing depression in primary care. British Medical Journal 2005; 330: 800–801.

12.

Wittchen

Hofler

Meister

. Prevalence and recognition of depressive syndromes in German primary care settings: Poorly recognized and treated? International Clinic of Psychopharmacology 2001; 16: 121–135.

13.

McCall

Clarke

Rowley

. A questionnaire to measure general practitioners' attitudes to their role in the management of patients with depression and anxiety. Australian Family Physician 2002; 31: 299–303.

14.

Botega

Mann

Blizard

Wilkinson

. General practitioners and depression—First use of the Depression Attitude Questionnaire. International Journal of Methods in Psychiatric Research 1992; 2: 169–180.

15.

Haddad

Walters

Tylee

. District nursing staff and depression: A psychometric evaluation of Depression Attitude Questionnaire findings. International Journal of Nursing Studies 2007; 44: 447–456.

16.

Kerr

Blizard

Mann

. General practitioners and psychiatrists: Comparison of attitudes to depression using the depression attitude questionnaire. British Journal of General Practitioners 1995; 45: 89–92.

17.

Botega

Silveira

. General practitioners attitudes towards depression: A study in primary care setting in Brazil. International Journal of Social Psychiatry 1996; 42: 230–237.

18.

King

Davidson

Taylor

. Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: Randomised controlled trial. British Medical Journal 2002; 324: 947–950.

19.

Dowrick

Gask

Perry

. Do general practitioners' attitudes towards depression predict their clinical behaviour? Psychology and Medicine 2000; 30: 413–419.

20.

Ross

Moffat

McConnachie

. Sex and attitude: A randomized vignette study of the management of depression by general practitioners. British Journal of General Practice 1999; 49: 17–21.

21.

Butler

Quayle

. Training primary care nurses in late-life depression: Knowledge, attitude and practice changes. International Journal of Older People Nursing 2007; 2: 25–35.

22.

Haddad

Plummer

Taverner

. District nurses' involvement and attitudes to mental health problems: A three-area cross-sectional study. Journal of Clinical Nursing 2005; 14: 976–985.

23.

Payne

Harvey

Jessopp

. Knowledge, confidence and attitudes towards mental health of nurses working in NHS Direct and the effects of training. Journal of Advanced Nursing 2002; 40: 549–559.

24.

Waller

Hillam

. Assessment of depression in older medical inpatients: Practice, attitudes and the effect of teaching. Aging and Mental Health 2000; 4: 275–277.

25.

Cape

Morris

Burd

Buszewicz

. Complexity of GPs' explanations about mental health problems: Development, reliability, and validity of a measure. British Journal of General Practice 2008; 58: 403–408, 410.

26.

Lecrubier

Boyer

Lepine

Weiller

. Results from the Paris Centre. In: Ustun

Sartorius

. Mental illness in general health care. An international study. Chichester: John Wiley & Sons, 1995.

27.

Norton

De Roquefeuil

Boulenger

. Use of the PRIME-MD Patient Health Questionnaire for estimating the prevalence of psychiatric disorders in French primary care: Comparison with family practitioner estimates and relationship to psychotropic medication use. General Hospital Psychiatry 2007; 29: 285–293.

28.

Norton

David

Boulenger

. General practitioners are bearing an increasing burden of the care of common mental disorders in France. European Journal of Psychiatry 2007; 21: 63–70.

29.

Réseau de Promotion pour la Santé Mentale 78. Rapport de l'enquête 2000 du Réseau de Promotion pour la Santé Mentale dans les Yvelines Sud. La Lettre de Promotion Santé Mentale Yvelines Sud, 2003, 4.

30.

Ministère de la Santé et des Solidarités. Arrêté du 13 juillet 2006 portant l'homologation des règles de validation de la formation médicale continue. Journal Officiel de la République Française, 2006.

31.

Linden

Lecrubier

Bellantuono

. The prescribing of psychotropic drugs by primary care physicians: An international collaborative study. Journal of Clinical Psychopharmacology 1999; 19: 132–140.

32.

Hull

Aquino

Cotter

. Explaining variation in antidepressant prescribing rates in east London: A cross sectional study. Family Practice 2005; 22: 37–42.

33.

Ustun

Sartorius

, editors. Mental illness in general health care. An international study. Chichester: John Wiley & Sons; 1995.

34.

Verger

. Déterminants de l'hétérogénéité des pratiques de prise en charge des problèmes de santé mentale en médecine de ville: Étude des prescriptions d'anti-dépresseurs par les médecins généralistes de la région Provence-Alpes-Côte d'Azur (PACA). In: Colloque “Représentations des troubles psychiques, pratiques de soins et vécu des malades.” Paris, 4 décembre 2006; 2006.

35.

Kisely

Duerden

Shaddick

Jayabarathan

. Collaboration between primary care and psychiatric services: Does it help family physicians? Canadian Family Physician 2006; 52: 876–877.

36.

Andersson

Lindberg

Troein

. What shapes GPs' work with depressed patients? A qualitative interview study. Family Practice 2002; 19: 623–631.

37.

The NICE Guideline on the Treatment and Management of Depression in Adults. National Clinical Practice Guideline 90. London: National Institute for Health and Clinical Excellence. National Health Service, 2009.

38.

WHO. Investing in mental health. Geneva: World Health Organization, 2003.

39.

Croudace

Evans

Harrison

. Impact of the ICD-10 Primary Health Care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care. Cluster randomised controlled trial. British Journal of Psychiatry 2003; 182: 20–30.

40.

Thompson

Kinmonth

Stevens

. Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet 2000; 355: 185–191.

41.

Gilbody

Whitty

Grimshaw

Thomas

. Educational and organizational interventions to improve the management of depression in primary care: A systematic review. Journal of the American Medical Association 2003; 289: 3145–3151.

42.

Dietrich

Oxman

Williams

Jr. . Re-engineering systems for the treatment of depression in primary care: Cluster randomised controlled trial. British Medical Journal 2004; 329: 602.

43.

Upshur

Weinreb

. A survey of primary care provider attitudes and behaviors regarding treatment of adult depression: What changes after a collaborative care intervention? Primary Care Companion Journal of Clinical Psychiatry 2008; 10: 182–186.

44.

Chew-Graham

Lovell

Roberts

. A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people. British Journal of General Practice 2007; 57: 364–370.

45.

Richards

Lovell

Gilbody

. Collaborative care for depression in UK primary care: A randomized controlled trial. Psychology and Medicine 2008; 38: 279–287.

46.

Nutting

Gallagher

Riley

. Care management for depression in primary care practice: Findings from the RESPECT-Depression trial. Annals of Family Medicine 2008; 6: 30–37.

47.

de Jong

van Steenbergen-Weijenburg

Huijbregts

. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands. International Journal of Integrative Care 2009; 9: e81.

48.

Deehan

Templeton

Taylor

. The effect of cash and other financial inducements on the response rate of general practitioners in a national postal study. British Journal of General Practice 1997; 47: 87–90.

49.

Templeton

Deehan

Taylor

. Surveying general practitioners: Does a low response rate matter? British Journal of General Practice 1997; 47: 91–94.

50.

DREES. Les médecins: Estimations au 1er janvier 2007, Ministère de l'Emploi et de la Solidarité, 2007, aout-sept 2007.

51.

Thornett

Pickering

Willis

Thompson

. Dowrick, found no relationship between the scores on the Depression Attitude Questionnaire and GPs' ability to identify depressed individuals in the surgery. Psychology and Medicine 2001; 31: 181.