Barriers to good management of depression in primary care: the views of GPs and nurses

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A research team from the Institute of Psychiatry in London have conducted a systematic review of qualitative and quantitative studies of General Practitioners’ and Practice Nurses’ attitudes to managing depression in primary care.

They found 7 qualitative and 10 quantitative studies, none of which looked at depressed people with co-morbid physical illness.

Two contrasting understandings of depression were identified:

  1. A normal response to life events
    Problems of everyday living such as isolation, loneliness, family breakdown and lack of social support, work stress (especially in suburban areas), housing problems, crime, unemployment and financial problems, illness, loss and reduction in function were seen as justifiably contributing to depression. Clinicians holding a ‘normalising’ understanding of depression found it difficult to distinguish between distress and depression and worried about medicalising social problems.
  2. A biomedical model of depression
    Depression is seen by some as ‘a medical condition distinct from everyday life’ which is caused by neurotransmitters or biochemical abnormality. This is associated with a view that depression is not inevitable and is treatable.

The study also explored the diagnosis and management of depression, shame and stigma, relationships between professionals, attitudes to managing depression and the training needs of clinicians.

The authors conclude:

Detection and management of depression is considered complex. In particular, primary care clinicians need guidance to address the social needs of depressed patients. It is not known whether the same issues are important when managing depressed people with co-morbid physical illness.

Barley EA, Murray J, Walters P, Tylee A. Managing depression in primary care: A meta-synthesis of qualitative and quantitative research from the UK to identify barriers and facilitators (Provisional PDF). BMC Fam Pract. 2011 Jun 9;12(1):47. [Epub ahead of print]

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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