Abstract:
The number of prescriptions for antidepressants has risen over the past two decades. The current study aims to explore the way that General Practitioners (GPs) understand the causes of depression and factors which influence their treatment decisions for depression, with a particular focus on antidepressants and gender differences in depression and its treatment. Responses were collected from 203 New Zealand GPs who responded to an anonymous online nationwide survey. Data was analysed using a mixed method approach. Overall, GPs’ explanations for depression were mixed, reflecting strong beliefs in psychosocial causes of depression in general, but biological explanations for severe depression. GPs believed strongly in the usefulness of talking therapies for all severities of depression, but particularly for mild to moderate depression. The majority of GPs considered medication as the most useful treatment for severe depression. A disconnect was found between value GPs’ ascribed to different therapy approaches, and their perspectives on their clinical practice; while only 10% of GPs classified medication as useful for mild depression, GPs reported prescribing more antidepressants to the majority of their patients with depression than referring for talking therapy. Several GP, patient and practice-environment factors were found to influence treatment decisions, such as GP’s gender, age, explanation for depression, beliefs in the usefulness of treatments; patient gender, severity of depression and demands; as well as consultation time and resource constraints, relationship with mental health services and professionals, and accessibility and affordability of secondary mental health professionals and services. GPs reported referring women for talking therapy more so than prescribing antidepressants, and reported prescribing antidepressants more so than referring men for talking therapy. This study is limited by being based on GP self-reports and an internet sample. Overall this study suggests GPs may benefit from one set of clear unambiguous guidelines for appropriate forms of depression treatment; as well as additional funding, resources and support from secondary services to encourage them to make greater use of talking therapy as treatment for depression when appropriate.