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Attitudes to depression and its treatment in primary care

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Weich, Scott, Morgan, Louise, King, Michael and Nazareth, Irwin. (2007) Attitudes to depression and its treatment in primary care. Psychological Medicine, Vol.37 (No.9). pp. 1239-1248. ISSN 0033-2917

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Official URL: http://dx.doi.org/10.1017/S0033291707000931

Abstract

Background Undertreatment of depression in primary care is common. Efforts to address this tend to overlook the role of patient attitudes. Our aim was to validate and describe responses to a questionnaire about attitudes to depression and its treatment in a sample with experience of moderate and severe depressive episodes. Method Cross-sectional survey of 866 individuals with a confirmed history of an ICD-10 depressive episode in the 12 months preceding interview, recruited from 7271 consecutive general practitioner (GP) attendees in 36 general practices in England and Wales. Attitudes to and beliefs about depression were assessed using a 19-item self-report questionnaire. Results Factor analysis resulted in a three-factor solution: factor 1, depression as a disabling, permanent state; factor 2, depression as a medical condition responsive to support; and factor 3, antidepressants are addictive and ineffective. Participants who received and adhered to antidepressant medication and disclosed their depression to family and friends had significantly lower scores on factors 1 and 3 but higher scores on factor 2. Conclusions People with moderate or severe depressive episodes have subtle and divergent views about this condition, its outcome, and appropriate help. Such beliefs should be considered in primary care as they may significantly impact on help seeking and adherence to treatment.

Item Type:	Journal Article
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Primary care (Medicine), Depression, Mental -- Diagnosis, Depression, Mental -- Treatment, Mental health surveys -- Great Britain, Mental health -- Great Britain
Journal or Publication Title:	Psychological Medicine
Publisher:	Cambridge University Press
ISSN:	0033-2917
Date:	11 June 2007
Volume:	Vol.37
Number:	No.9
Page Range:	pp. 1239-1248
Identification Number:	10.1017/S0033291707000931
Status:	Peer Reviewed
Access rights to Published version:	Open Access
References:	Anderson, C. M., Robins, C. S., Greeno, C. G., Cahalane, H., Copeland, V. C. & Andrews, R. M. (2006). Why lower income mothers do not engage with the formal mental health care system: perceived barriers to care. Qualitative Health Research 16, 926–943. Bebbington, P. E., Brugha, T. S., Meltzer, H., Jenkins, R., Ceresa, C., Farrell, M. & Lewis, G. (2000). Neurotic disorders and the receipt of psychiatric treatment. Psychological Medicine 30, 1369–1376. Botega, N., Mann, A., Blizard, R. & Wilkinson, G. (1992). General practitioners and depression – first use of the Depression Attitude Questionnaire. International Journal of Methods in Psychiatric Research 2, 169–180. Brugha, T. S. (1995). Depression undertreatment: lost cohorts, lost opportunities? Psychological Medicine 25, 3–6. Brugha, T. S., Bebbington, P. E., Singleton, N., Melzer, D., Jenkins, R., Lewis, G., Farrell, M., Bhugra, D., Lee, A. & Meltzer, H. (2004). Trends in service use and treatment for mental disorders in adults throughout Great Britain. British Journal of Psychiatry 185, 378–384. Cattell, R. B. (1966). The scree test for the number of factors. Multivariate Behavioral Research 1, 245–276. Cooper-Patrick, L., Powe, N. R., Jenckes, M. W., Gonzales, J. J., Levine, D. M. & Ford, D. E. (1997). Identification of patient attitudes and preferences regarding treatment of depression. Journal of General Internal Medicine 12, 431–438. Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J. P., Angermeyer, M. C., Bernert, S., de Girolamo, G., Morosini, P., Polidori, G., Kikkawa, T., Kawakami, N., Ono, Y., Takeshima, T., Uda, H., Karam, E. G., Fayyad, J. A., Karam, A. N., Mneimneh, Z. N., Medina-Mora, M. E., Borges, G., Lara, C., de Graaf, R., Ormel, J., Gureje, O., Shen, Y., Huang, Y., Zhang, M., Alonso, J., Haro, J. M., Vilagut, G., Bromet, E. J., Gluzman, S., Webb, C., Kessler, R. C., Merikangas, K. R., Anthony, J. C., Von Korff, M. R., Wang, P. S., Brugha, T. S., Aguilar-Gaxiola, S., Lee, S., Heeringa, S., Pennell, B. E., Zaslavsky, A. M., Ustun, T. B. & Chatterji, S. (2004). Prevalence, severity and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association 291, 2581–2590. Department of Health (2001). Treatment Choice in Psychological Therapies and Counselling: Evidence Based Clinical Practice Guideline. Department of Health: London. DiMatteo, M. R. & Haskard, K. B. (2006). Further challenges in adherence research. Medical Care 44, 297–299. Dwight-Johnson, M., Sherbourne, C. D., Liao, D. & Wells, K. B. (2000). Treatment preferences among depressed primary care patients. Journal of General Internal Medicine 15, 527–534. Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E. & Kessler, R. C. (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry 159, 845–851. Garber, M., Nau, D., Erickson, S., Aikens, J. & Lawrence, J. (2004). The concordance of self-report with other measures of medication adherence: a summary of the literature. Medical Care 42, 649–652. Hennekens, C. H. & Buring, J. E. (1987). Epidemiology in Medicine. Little, Brown: Boston. Jorm, A. F., Griffiths, K. M., Christensen, H., Parslow, R. A. & Rogers, B. (2004). Actions taken to cope with depression at different levels of severity: a community survey. Psychological Medicine 34, 293–299. Kendrick, T. (2000). Why can't GPs follow guidelines on depression? British Medical Journal 320, 200–201. Kessing, L., Hansen, H. V., Demyttenaere, K. & Bech, P. (2005). Depressive and bipolar disorders: patients' attitudes and beliefs towards depression and antidepressants. Psychological Medicine 35, 1205–1213. King, M., Nazareth, I., Lampe, F., Bower, P., Chandler, M., Morou, M., Sibbald, B. & Lai, R. (2005). Impact of participant and physician intervention preferences on randomized trials: a systematic review. Journal of the American Medical Association 293, 1089–1099. Layard, R. (2006). The case for psychological treatment centres. British Medical Journal 332, 1030–1032. Lin, E. & Parikh, S. V. (1999). Sociodemographic, clinical, and attitudinal characteristics of the untreated depressed in Ontario. Journal of Affective Disorders 53, 153–162. Lin, P., Campbell, D. G., Chaney, E. F., Liu, C.-F., Heagerty, P., Felker, B. L. & Hedrick, S. C. (2005). The influence of patient preference on depression treatment in primary care. Annals of Behavioral Medicine 30, 164–173. Murray, C. J. L. & Lopez, A. D. (1997). Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 349, 1498–1504. NICE (2004). Management of Depression in Primary and Secondary Care. Clinical Guideline 23. National Institute for Clinical Excellence: London. Nutting, P., Rost, K., Dickinson, M., Werner, J. J., Dickinson, P., Smith, J. L. & Gallovic, B. (2002). Barriers to initiating depression treatment in primary care practice. Journal of General Internal Medicine 17, 103–111. Priest, R. G., Vize, C., Roberts, A., Roberts, M. & Tylee, A. (1996). Lay people's attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch. British Medical Journal 313, 858–859. Pyne, J. M., Rost, K. M., Farahati, F., Tripathi, S. P., Smith, J., Williams, K. D., Fortney, J. & Coyne, J. C. (2005). One size fits some: the impact of patient treatment attitudes on the cost-effectiveness of a depression primary care intervention. Psychological Medicine 35, 839–854. Rost, K., Nutting, P., Smith, J., Werner, J. & Duan, N. (2001). Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming. Journal of General Internal Medicine 16, 143–149. Scott, J. (2006). Depression should be managed like a chronic disease. British Medical Journal 332, 985–986. Singleton, N., Bumpstead, R., O'Brien, M., Lee, A. & Meltzer, H. (2001). Psychiatric Morbidity Among Adults Living in Private Households, 2000. The Stationery Office: London. StataCorp (2004). Stata Statistical Software: Release 8.0. Stata Corporation: College Station, TX. Thomas, C. M. & Morris, S. (2003). Cost of depression among adults in England in 2000. British Journal of Psychiatry 183, 514–519. Thompson, C., Kinmonth, A.-L., Stevens, L., Peveler, R. C., Stevens, A., Ostler, K. J., Pickering, R. M., Baker, N. G., Henson, A., Preece, J., Cooper, D. & Campbell, M. J. (2000). Effects of clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet 355, 185–191. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B. & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States. Archives of General Psychiatry 62, 629–640. Weich, S. & Lewis, G. (1998). Poverty, unemployment and common mental disorders: population-based cohort study. British Medical Journal 317, 115–119. WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva. WHO (1997). Composite International Diagnostic Interview (Core Version 2.1). World Health Organization: Geneva. Young, A. S., Klap, R., Sherbourne, C. D. & Wells, K. B. (2001). The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry 58, 55–61.
URI:	http://wrap.warwick.ac.uk/id/eprint/675