Do family physicians and internists differ in knowledge, attitudes, and self-reported approaches for depression?
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
Strategies to improve mental health care should account for the orientation of primary care physicians to mental health issues.
Gallo
Joseph J
JJ
Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia 19104, USA. jjgallo@mail.med.upenn.edu
Meredith
Lisa S
LS
Gonzales
Junius
J
Cooper
Lisa A
LA
Nutting
Paul
P
Ford
Daniel E
DE
Rubenstein
Lisa
L
Rost
Kathryn
K
Wells
Kenneth B
KB
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D011361:Professional Competence; D011613:Psychotherapy; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D000078329:Workforce
D000928:Antidepressive Agents