title: Improving care in depression: qualitative study investigating the effects of using a mental health questionnaire.
abstract: BACKGROUND
  Depression has major health and social consequences. There is concern that general practitioners (GPs), who manage most depression in primary care, are reluctant to use assessment tools such as questionnaires that might improve diagnosis and management. A Cochrane systematic review has recommended qualitative exploratory studies to explore the impact of questionnaires on GP management.
  
  
  OBJECTIVE
  To identify effects of using mental health questionnaires on views of GPs managing depression, and how this might influence patient care.
  
  
  METHODS
  Qualitative, formative evaluation using principles of grounded theory in analysis of semi-structured interviews and focus groups before and after introducing the mental health questionnaire.
  
  
  METHODS
  Four practices in South London.
  
  
  METHODS
  Twenty GPs, of whom four contributed to the pilot only, and 16 completed the main study.
  
  
  METHODS
  Identification of changes in GP views as a result of using the questionnaire with patients.
  
  
  RESULTS
  Three themes emerged from analysis of GP views on managing depression: control and responsibility; the doctor-patient relationship, and support for the doctor. These were influenced by GPs' experience (years in practice), and perceived time spent dealing with depression (involvement). Use of the questionnaire enabled more experienced GPs to relinquish control, encourage patient involvement, and offer alternative sources of help. They felt less responsible for overall care. Less experienced, and less involved GPs found questionnaires supportive through increasing their confidence in asking difficult questions, and were encouraged to look for depression, which they might previously have avoided.
  
  
  CONCLUSIONS
  Using mental health questionnaires helped GPs feel more confident in detecting and managing depression, and there was greater willingness to use questionnaires than found in previous studies. Most GPs sought reduced responsibility in ongoing care, using questionnaires to involve patients and pass responsibility to them or other agencies.
authors.affiliation: Ballater Surgery, Orpington, UK. jackie@tavabie.com
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Tavabie
authors.forename: Oliver D
authors.initials: OD
authors.lastname: Tavabie
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D036301:Qualitative Research; D011795:Surveys and Questionnaires