Todman Jonathan P F, Law Jim, MacDougall Andrew
NHS Highland Department of Psychological Services, New Craigs Hospital, Inverness, Scotland.
Rural Remote Health. 2011;11(1):1496. Epub 2011 Feb 3.
The mental health of older adults is of increasing concern in an aging population and GPs are frequently the gatekeepers to specialist mental health services. Psychotherapy, social interventions and bibliotherapy all have an evidence-base for treating depression and anxiety in the elderly, as does pharmacological treatment. However, the referral rate from GPs for an Older Adults Clinical Psychology service in the Scottish Highlands in the months prior to the study had been very low and the reasons for this were not clear. General practitioners may have felt that depression and anxiety are 'understandable' in older adults and are therefore unsuitable for treatment, or they may have felt that psycho-pharmacotherapy treatments are more effective than the psychotherapy treatment options. Alternatively, local issues associated with the remote location of many NHS Highland GP practices and patients may have prevented them referring. Therefore, the current study aimed to elicit the therapeutic preferences of Highland GPs, the perceived availability of these options and an estimate of the prevalence of older adults in the area suffering from mild or moderate mental health problems.
Questionnaires including brief quantitative and qualitative questions were sent to all 284 GPs in the area with 119 (46%) were completed and returned.
Responses from GPs suggested that many patients with depression or anxiety may not be referred. The GPs indicated that social therapeutic options are seen to be as effective as pharmacological options and more effective than other psychological and bibliotherapy options. However, GPs indicated that they were substantially more likely to prescribe pharmacological options than other forms of therapy. The GPs suggested that lower waiting times and a more localised service would increase the likelihood of a referral being made.
The current study suggests that low awareness of psychological service provision among GPs may have resulted in fewer referrals, rather than low confidence in psychotherapies for this population. The GPs' preference for social interventions may reflect the particular risk of isolation of the elderly in remote communities and may be worthy of consideration when developing services in these areas.
在人口老龄化的背景下，老年人的心理健康问题日益受到关注，全科医生（GPs）常常是专科心理健康服务的守门人。心理治疗、社会干预和阅读疗法都有证据表明可用于治疗老年人的抑郁症和焦虑症，药物治疗也是如此。然而，在研究前几个月，苏格兰高地全科医生将患者转介至老年人临床心理学服务的比例一直很低，原因尚不清楚。全科医生可能认为老年人的抑郁和焦虑是“可以理解的”，因此不适合治疗，或者他们可能觉得心理药物治疗比心理治疗方案更有效。此外，与高地国民保健服务（NHS）许多全科医生诊所及患者地处偏远相关的当地问题，可能阻碍了他们进行转介。因此，本研究旨在了解高地全科医生的治疗偏好、这些治疗方案的可获得性认知，以及对该地区患有轻度或中度心理健康问题的老年人患病率的估计。
向该地区所有284名全科医生发放了包含简短定量和定性问题的问卷，共119份（46%）问卷被填写并返还。
全科医生的回复表明，许多患有抑郁症或焦虑症的患者可能未被转介。全科医生指出，社会治疗方案被认为与药物治疗方案一样有效，且比其他心理和阅读疗法更有效。然而，全科医生表示，他们开药物治疗方案的可能性远高于其他治疗形式。全科医生认为，缩短等待时间和提供更本地化的服务将增加转介的可能性。
当前研究表明，全科医生对心理服务提供的认知度较低可能导致转介减少，而非对该人群心理治疗缺乏信心。全科医生对社会干预的偏好可能反映了偏远社区老年人面临的特殊孤立风险，在这些地区开展服务时可能值得考虑。
