Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial.
BACKGROUND
In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP).


METHODS
One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ ICD-10 major depression checklist.


RESULTS
The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists.


CONCLUSIONS
Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials.
Levav
Itzhak
I
Ministry of Health, Jerusalem, Israel.
Kohn
Robert
R
Montoya
Ivan
I
Palacio
Carlos
C
Rozic
Pablo
P
Solano
Ida
I
Valentini
Willians
W
Vicente
Benjamin
B
Morales
Jorge Castro
JC
Eigueta
Francisco Espejo
FE
Saravanan
Yamini
Y
Miranda
Claudio T
CT
Sartorius
Norman
N
D000293:Adolescent; D017281:Cost of Illness; D003710:Demography; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D004493:Education; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007843:Latin America; D008297:Male; D008604:Mental Health Associations; D010821:Physicians, Family / Q000193:education*; D011570:Psychiatry / Q000379:methods*