title: "A powerful intervention: general practitioners'; use of sickness certification in depression".
abstract: BACKGROUND
  Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression. This study aimed to explore GPs views of sickness certification in relation to depression.
  
  
  METHODS
  A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009.
  
  
  RESULTS
  A total of 30 GPs were interviewed. A number of common themes emerged including the perceived importance of GP advocacy on behalf of their patients, the tensions between stakeholders involved in the sickness certification system, the need to respond flexibly to patients who present with depression and the therapeutic nature of time away from work as well as the benefits of work. GPs reported that most patients with depression returned to work after a short period of absence and that it was often difficult to predict which patients would struggle to return to work.
  
  
  CONCLUSIONS
  GPs reported that dealing with sickness certification and depression presents distinct challenges. Sickness certificates are often viewed as powerful interventions, the effectiveness of time away from work for those with depression should be subject to robust enquiry.
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 1, Horselethill Road, Glasgow, G12 9LX, UK. sara.macdonald@glasgow.ac.uk
authors.forename: Sara
authors.initials: S
authors.lastname: Macdonald
authors.forename: Margaret
authors.initials: M
authors.lastname: Maxwell
authors.forename: Philip
authors.initials: P
authors.lastname: Wilson
authors.forename: Michael
authors.initials: M
authors.lastname: Smith
authors.forename: Will
authors.initials: W
authors.lastname: Whittaker
authors.forename: Matt
authors.initials: M
authors.lastname: Sutton
authors.forename: Jill
authors.initials: J
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents; D002568:Certification / Q000706:statistics & numerical data*; D003657:Decision Making; D003863:Depression / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D020793:Gatekeeping; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000517:prevention & control / Q000628:therapy; D010317:Partnership Practice / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*; D024382:Professional Role; D012606:Scotland; D018582:Sick Leave
chemical_list: D000928:Antidepressive Agents