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GP treatment decisions for patients with depression: an observational study

GP treatment decisions for patients with depression: an observational study
GP treatment decisions for patients with depression: an observational study
Background: GPs are prescribing more antidepressants than previously, but not in accordance with guidelines. The reasons why they prescribe are not well understood.
Aim: To explore associations between GP treatment and severity of depression, patients' life difficulties, previous history of illness and treatment, and patient attitudes.
Design: Observational study in two phases, 3 years apart.
Setting: Seven practices in Southampton, UK.
Method: Adult attenders who consented were screened for depression in the waiting room. After the consultation, the 17 participating GPs completed questionnaires on the perceived presence and severity of depression, patients' life difficulties, previous problems and treatment, patient attitudes towards antidepressants, and their treatment decisions. Patients returned postal questionnaires on sociodemographics, life events, physical health, and attitudes towards antidepressants.
Results: Of 694 patients screened in the two phases, the GPs rated 101 (15%) as depressed, acknowledged depression in 44 cases (6%), and offered treatment in 27 (4%), including antidepressants in 14 (2%). Offers of antidepressants were more likely in both phases where the GPs rated the depression as moderate rather than mild, and where they perceived a positive patient attitude to antidepressants. However, GP ratings of severity did not agree well with the validated screening instrument, and their assessments of patients' attitudes to treatment were only moderately related to patients' self-reports.
Conclusions: In line with current guidelines, GPs base prescribing decisions on the perceived severity of depression, taking patients' preferences into account, but they do not accurately identify which patients are likely to benefit from treatment. Better ways to assess depression severity and patient attitudes towards antidepressants are needed in order to target treatment more appropriately.
antidepressants, depression, prescribing
0960-1643
280-286
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
King, Fiona
e6ab839e-92e7-4984-b5bd-62f4caf173bf
Albertella, Louise
b2be7a4d-e68c-43b6-a990-0313629043da
Smith, Peter W.F.
961a01a3-bf4c-43ca-9599-5be4fd5d3940
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
King, Fiona
e6ab839e-92e7-4984-b5bd-62f4caf173bf
Albertella, Louise
b2be7a4d-e68c-43b6-a990-0313629043da
Smith, Peter W.F.
961a01a3-bf4c-43ca-9599-5be4fd5d3940

Kendrick, Tony, King, Fiona, Albertella, Louise and Smith, Peter W.F. (2005) GP treatment decisions for patients with depression: an observational study. British Journal of General Practice, 55 (513), 280-286.

Record type: Article

Abstract

Background: GPs are prescribing more antidepressants than previously, but not in accordance with guidelines. The reasons why they prescribe are not well understood.
Aim: To explore associations between GP treatment and severity of depression, patients' life difficulties, previous history of illness and treatment, and patient attitudes.
Design: Observational study in two phases, 3 years apart.
Setting: Seven practices in Southampton, UK.
Method: Adult attenders who consented were screened for depression in the waiting room. After the consultation, the 17 participating GPs completed questionnaires on the perceived presence and severity of depression, patients' life difficulties, previous problems and treatment, patient attitudes towards antidepressants, and their treatment decisions. Patients returned postal questionnaires on sociodemographics, life events, physical health, and attitudes towards antidepressants.
Results: Of 694 patients screened in the two phases, the GPs rated 101 (15%) as depressed, acknowledged depression in 44 cases (6%), and offered treatment in 27 (4%), including antidepressants in 14 (2%). Offers of antidepressants were more likely in both phases where the GPs rated the depression as moderate rather than mild, and where they perceived a positive patient attitude to antidepressants. However, GP ratings of severity did not agree well with the validated screening instrument, and their assessments of patients' attitudes to treatment were only moderately related to patients' self-reports.
Conclusions: In line with current guidelines, GPs base prescribing decisions on the perceived severity of depression, taking patients' preferences into account, but they do not accurately identify which patients are likely to benefit from treatment. Better ways to assess depression severity and patient attitudes towards antidepressants are needed in order to target treatment more appropriately.

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More information

Published date: April 2005
Keywords: antidepressants, depression, prescribing

Identifiers

Local EPrints ID: 40662
URI: http://eprints.soton.ac.uk/id/eprint/40662
ISSN: 0960-1643
PURE UUID: 3931fe53-f434-410c-b6d5-0ad6bb734f61
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381
ORCID for Peter W.F. Smith: ORCID iD orcid.org/0000-0003-4423-5410

Catalogue record

Date deposited: 07 Jul 2006
Last modified: 09 Jan 2022 02:57

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Contributors

Author: Tony Kendrick ORCID iD
Author: Fiona King
Author: Louise Albertella

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