title: The attitudes and beliefs of Pakistani medical practitioners about depression: a cross-sectional study in Lahore using the Revised Depression Attitude Questionnaire (R-DAQ).
abstract: BACKGROUND
  Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals' attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan.
  
  
  METHODS
  A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ). A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey.
  
  
  RESULTS
  Six hundred and one (86 %) of the doctors approached consented to participate; almost all respondents (99 %) endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes), and 37 % (between 13 and 19 % for particular causes) noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression.
  
  
  CONCLUSIONS
  Non-psychiatrist medical practitioners in Pakistan hold a range of views about the causes of depression, with supernatural explanations held by more than a third. Depression attitudes appear less positive than among UK and European clinicians, with the notions that depression is due to a lack of stamina and will-power and a natural part of growing old being especially commonly held; more positive attitudes appear to be associated with a rejection of supernatural explanatory models of depression.
authors.affiliation: Centre for Mental Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK. mark.haddad.1@city.ac.uk.|East London NHS Foundation Trust, London, UK. mark.haddad.1@city.ac.uk.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0002-4822-5482
authors.initials: M
authors.lastname: Haddad
authors.affiliation: CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Waqas
authors.affiliation: CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
authors.forename: Wahhaj
authors.initials: W
authors.lastname: Qayyum
authors.affiliation: CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
authors.forename: Maryam
authors.initials: M
authors.lastname: Shams
authors.affiliation: CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
authors.forename: Saad
authors.initials: S
authors.lastname: Malik
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010820:Physicians / Q000523:psychology; D011570:Psychiatry; D011795:Surveys and Questionnaires