Clinicians' attitudes to depression in Europe: a pooled analysis of Depression Attitude Questionnaire findings

Background. Depression in primary care is common but under-recognized and suboptimally managed. Health professionals' attitudes are likely to play an important part in their recognition and management of depression. Objectives. To pool findings from studies using the Depression Attitude Questionnaire (DAQ) to provide greater detail of clinicians' attitudes and the measure's psychometric properties. Methods. Electronic databases and grey literature were searched for relevant studies. Data from eligible studies were requested and pooled analysis conducted. Results. Twenty studies were eligible and data were obtained from 12 of these involving GPs (n = 1543) and nurses (n = 984). Responses showed strong disagreement that depression is due to ageing or weakness. European GPs were more positive about depression treatments than UK GPs; nurses were more favourable about psychotherapy than GPs. UK GPs especially strongly opposed notions that depression is best managed by psychiatrists. Trends over time indicated increasing acknowledgement of psychological therapies and the nurse's role in depression management. Factor analysis indicated that many DAQ items fitted weakly within an overall model. The most parsimonious solution involved two factors: a positive view of depression and its treatment response and professional confidence in depression management. Conclusions. Individual DAQ items appear to measure key aspects of clinicians' attitudes to depression, and item responses indicate important differences between professions and geographical settings as well as changes over time. There are problems with the DAQ as a scale: its internal consistency is weak, and several items appear specific to particular professions or service structures, indicating that this questionnaire should be revised.