Manzanera Ricardo, Lahera Guillermo, Álvarez-Mon Miguel Ángel, Alvarez-Mon Melchor
National Health System, General Practice, London, UK.
Department of Medicine and Medical Specialties, University of Alcalá, CIBERSAM, Madrid, Spain.
Fam Pract. 2018 Jan 16;35(1):61-66. doi: 10.1093/fampra/cmx071.
Family doctors' (FD) attitudes likely play an important role in the recognition and management of depression.
The purpose of the study was to prospectively analyse the short-term and long-term impact of a specifically designed training program on attitudes towards depression among FDs.
A prospective, educational intervention, single group pre- and post-test study with three assessments (pre, post, and 6-month follow-up) was conducted. Participants included 1322 certified FDs who had enrolled voluntarily in a structured postgraduate training in depression. This course was mainly practical and guided by case reports and real clinical experiences. The course was based on Patient's Unmet Needs and Doctors Educational Needs (PUNS & DENS) methodology. Primary outcome was assessed through the Depression Attitudes Questionnaire (DAQ). In total, 970 subjects completed the pre-post assessments, and 787 also completed the 6-month follow-up.
After training, FDs positively changed their attitudes towards the management of depression. A significant change was observed in 18 of 20 items of the DAQ. The distinction between unhappiness and depression was initially found to be difficult in 41% of FDs. After the course, the percentage was reduced to 27%. Agreement with the statement that 'psychotherapy is an exclusive practice of specialists' strikingly changed from 57% to 23%. Minimal differences were noted between the post-training assessment and the 6-month follow-up.
Attitudes towards depression in FDs can be modified by a structured training program, and this change is maintained over the long term. A short training in psychotherapy (cognitive-behavioural, problem-solving based and psycho-educative oriented) significantly increases the confidence of FDs in treating depression.
家庭医生（FD）的态度可能在抑郁症的识别和管理中发挥重要作用。
本研究的目的是前瞻性分析一项专门设计的培训计划对家庭医生对抑郁症态度的短期和长期影响。
进行了一项前瞻性、教育干预、单组前后测研究，共进行三次评估（前测、后测和6个月随访）。参与者包括1322名获得认证的家庭医生，他们自愿参加了抑郁症结构化研究生培训。本课程主要是实践性的，以病例报告和实际临床经验为指导。该课程基于患者未满足的需求和医生教育需求（PUNS&DENS）方法。主要结局通过抑郁态度问卷（DAQ）进行评估。共有970名受试者完成了前后测评估，787名受试者还完成了6个月随访。
培训后，家庭医生对抑郁症管理的态度发生了积极变化。DAQ的20项中有18项观察到显著变化。最初，41%的家庭医生难以区分不快乐和抑郁症。课程结束后，这一比例降至27%。同意“心理治疗是专科医生的专属业务”这一说法的比例从57%显著降至23%。培训后评估与6个月随访之间差异极小。
结构化培训计划可改变家庭医生对抑郁症的态度，且这种变化能长期维持。短期心理治疗培训（认知行为、基于问题解决和以心理教育为导向）可显著提高家庭医生治疗抑郁症的信心。
