Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
Institute of Psychiatry, Hospital das Clínicas, FMUSP, São Paulo, Brazil.
PLoS One. 2022 Apr 5;17(4):e0265308. doi: 10.1371/journal.pone.0265308. eCollection 2022.
The objective of our study was to explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC) in four Latin Americans countries, through the application of clinical vignettes.
Using a cross-sectional design, we conducted a self-administered online questionnaire survey of psychiatrists from Bolivia, Brazil, Cuba, and Chile. The questionnaire covered sociodemographic and professional information. The psychiatrists' clinical decisions were assessed through three clinical vignettes representing typical PC cases of depression, anxiety, and somatization.
230 psychiatrists completed the online survey. Psychiatrists from Brazil were less likely to recognize depression as a mental disorder than those from Cuba (odds ratio (OR) = 0.30, 95% confidence interval (CI), 0.10 to 0.91, p < 0.04). Female gender (OR = 0.19, 95% CI, 0.04 to 0.91, p < 0.02) and older age (OR = 0.92, 95% CI, 0.87 to 0.97, p < 0.01) reduced the likelihood of agreement that depression cases should be treated by a Primary Care Physician (PCP). In the somatoform symptoms vignette, longer training duration increased the likelihood of agreement that treatment should be done by a psychiatrist instead of a PCP (OR = 1.19, 95% CI, 1.04 to 1.37, p < 0.01). In the anxiety vignette, females (OR = 2.38, 95% CI, 1.10 to 5.13, p < 0.01) and participants from Bolivia (compared with Cubans, OR = 4.19, 95% CI, 1.22 to 14.42, p < 0.02) were more likely to consider that these patients should be treated by a psychiatrist instead of a PCP.
Most psychiatrist respondents agreed that patients with depression should be treated by PCPs and that somatoform and anxiety cases should be treated by psychiatrists. These results show that psychiatrists consider that they, and not PCPs, should treat patients with common mental disorders, regardless of the evidence showing that common mental disorders can be treated by primary care physicians in PC.
我们的研究目的是通过应用临床病例来探讨拉丁美洲四个国家的初级保健（PC）中精神科医生治疗常见精神障碍的临床决策。
我们采用横断面设计，对来自玻利维亚、巴西、古巴和智利的精神科医生进行了自我管理的在线问卷调查。问卷涵盖了社会人口统计学和专业信息。通过三个临床病例来评估精神科医生的临床决策，这些病例代表了抑郁、焦虑和躯体化的典型 PC 病例。
230 名精神科医生完成了在线调查。与来自古巴的精神科医生相比，巴西的精神科医生不太可能将抑郁症视为一种精神障碍（比值比（OR）=0.30，95%置信区间（CI）0.10 至 0.91，p<0.04）。女性（OR=0.19，95%CI 0.04 至 0.91，p<0.02）和年龄较大（OR=0.92，95%CI 0.87 至 0.97，p<0.01）降低了同意应由初级保健医生（PCP）治疗抑郁症病例的可能性。在躯体症状病例中，较长的培训时间增加了同意应由精神科医生而不是 PCP 治疗的可能性（OR=1.19，95%CI 1.04 至 1.37，p<0.01）。在焦虑病例中，女性（OR=2.38，95%CI 1.10 至 5.13，p<0.01）和来自玻利维亚的参与者（与古巴人相比，OR=4.19，95%CI 1.22 至 14.42，p<0.02）更有可能认为这些患者应由精神科医生而不是 PCP 治疗。
大多数精神科医生受访者认为抑郁症患者应由 PCP 治疗，躯体形式和焦虑症病例应由精神科医生治疗。这些结果表明，精神科医生认为他们，而不是 PCP，应该治疗常见精神障碍患者，尽管有证据表明常见精神障碍可以由 PC 中的初级保健医生治疗。
