title: Managing depression in primary care: community survey.
abstract: OBJECTIVE
  To investigate family physicians' practice patterns for managing depression and mental health concerns among adolescent and adult patients.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  London, Ont, a mid-sized Canadian city.
  
  
  METHODS
  One hundred sixty-three family physicians identified through the London and District Academy of Medicine.
  
  
  METHODS
  Practice patterns for managing depression, including screening, pharmacotherapy, psychotherapy, shared care, and training needs.
  
  
  RESULTS
  Response rate was 63%. Family physicians reported spending a substantial portion of their time during patient visits (26% to 50%) addressing mental health issues, with depression being the most common issue (51% to 75% of patients with mental health issues). About 40% of respondents did routine mental health screening, and 60% screened patients with risk factors for depression. Shared care with mental health professionals was common (care was shared for 26% to 50% of patients). Physicians and patients were moderately satisfied with shared care, but were frustrated by long waiting lists and communication barriers. Most physicians provided psychotherapy to patients in the form of general advice. Differences in practice patterns were observed; physicians treated more adults than adolescents with depression, and they reported greater comfort in treating adults. Although 33% of physicians described using cognitive behavioural therapy (CBT), they reported having little training in CBT. Moderate interest was expressed in CBT training, with a preference for a workshop format.
  
  
  CONCLUSIONS
  Although 40% of family physicians routinely screen patients for mental health issues, depression is often not detected. Satisfaction with shared care can be increased through better communication with mental health professionals. Physicians' management of adolescent patients can be improved by further medical training, consultation, and collaboration with mental health professionals. Training in evidence-based treatment of depression is particularly warranted given physicians' limited knowledge of CBT.
authors.affiliation: London Health Sciences Centre, Department of Psychiatry, Schulich School of Medicine, University of Western Ontario, Canada. kerry.collins@lhsc.on.ca
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Collins
authors.forename: Vicky V
authors.initials: VV
authors.lastname: Wolfe
authors.forename: Sandra
authors.initials: S
authors.lastname: Fisman
authors.forename: JoAnne
authors.initials: J
authors.lastname: DePace
authors.forename: Margaret
authors.initials: M
authors.lastname: Steele
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening; D011364:Professional Practice; D014505:Urban Population