Do Family Physicians and Internists Differ in Knowledge, Attitudes, and Self-Reported Approaches for Depression?

• Published in: International journal of psychiatry in medicine Vol. 32; no. 1; pp. 1 - 20
• Main Authors: Gallo, Joseph J., Meredith, Lisa S., Gonzales, Junius, Cooper, Lisa A., Nutting, Paul, Ford, Daniel E., Rubenstein, Lisa, Rost, Kathryn, Wells, Kenneth B.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2002; Baywood; Sage Publications Ltd
• Subjects: Adult; Antidepressive Agents - therapeutic use; Attitude to Health; Biological and medical sciences; Depression - diagnosis; Depression - drug therapy; Depression - therapy; Female; Health staff related problems. Vocational training; Humans; Internal medicine; Internal Medicine - manpower; Male; Medical sciences; Mental depression; Mental health; Middle Aged; Physicians; Physicians, Family; Primary care; Professional Competence; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Self-Assessment; Social psychiatry. Ethnopsychiatry; Surveys and Questionnaires; United States; North America; America; Attitude of health personnel; primary health care; practice; depression; attitudes; knowledge; Mood disorder; Social environment; Human; Attitude; Self evaluation; General practitioner; Health staff; Decision making; Primary health care; Multicenter study; Mental health; Depression; Knowledge; Treatment; Resident(student); Medical prescription; Professional competence; Professional practice; Comparative study; Occupational training; Public health
• ISSN: 0091-2174; 1541-3527
• DOI: 10.2190/7QNE-ENF5-2KEL-723X

Objectives: The purpose of this investigation was to assess the relationship of primary care specialty training with self-assessed skill, knowledge, attitudes, and behavior toward depression recognition and management. Method: A baseline self-report questionnaire was administered to 184 internists and 138 family physicians participating in a multisite depression intervention study. Results: There were no marked differences in knowledge of internists and family physicians regarding depression, in attitudes about the effectiveness of specific therapies, or in barriers to providing optimum treatment for depression. However, compared to internists, family physicians rated themselves as more skilled in the management of depression. When considering management of patients with moderate to severe depression, family physicians were more likely to report that they prescribed a selective serotonin-reuptake inhibitor (relative odds (RO) = 3.51, 95 percent Confidence interval (CI) [2.19, 5.60] and to personally counsel patients (RO = 1.97, 95 percent CI [1.16, 3.38]) more than half the patients, but were less likely to refer to a specialist in mental health (RO = 0.52, 95 percent CI [0.33, 0.82]) than were internists. Additional potentially influential characteristics did not wholly account for the reported differences in practice according to specialty. Physicians of both specialties expressed considerable uncertainty in their knowledge of psychotherapy and in their evaluation of the effectiveness of other strategies for the prevention of recurrence of depression. Conclusion: Strategies to improve mental health care should account for the orientation of primary care physicians to mental health issues.