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

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.