[An educational training program for physicians for diagnosis and treatment of depression].
OBJECTIVE
The American Regional Office of the WHO has launched a major initiative to reduce the prevalence of affective disorders region-wide that includes focusing on the primary health care system. This study evaluated the results of an educational training program for Brazilian primary care physicians that measured changes in knowledge, attitudes, and practice.


METHODS
A total of 17 primary care physicians and 1,224 patients participated in the study. Physician's knowledge, attitudes, and clinical practice were assessed one-month prior and one-month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times.


RESULTS
The training program showed limited benefits in this small sample of physicians. The program was unable to demonstrate benefit in improving knowledge about depression and in changing disorder-related attitudes. There were no changes in the diagnostic rates of major depression. There was some evidence to support improvement in psychopharmacological management. The physicians seemed more confident in treating patients, as there was a reduction of referrals to the specialists. Lack of statistical power prevented the latter two findings from reaching statistical significance.


CONCLUSIONS
The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression. However, more effective methods of training Brazilian primary care physicians in the management of major depression need to be tested.
Serviço de Saúde Dr. Cândido Ferreira, Campinas, SP, Brazil. wvalentini@dglnet.com.br
Willians
W
Valentini
Itzhak
I
Levav
Robert
R
Kohn
Claudio T
CT
Miranda
Andrea de Abreu Feijó de
AA
Mello
Marcelo Feijó de
MF
Mello
Cássia P
CP
Ramos
D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education*; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D012959:Socioeconomic Factors