GPs' beliefs about their management of depression and needs for supporting change in practice

Guidelines for general practitioners (GPs) about depression have emphasised prescribing behaviour more than patent centred care. There is a debate about how GPs should prescribe antidepressants. GPs do not prioritise the management of depression in their continuing education. This paper describes GPs' beliefs about their clinical management of depression, their support needs and interest in changing practice. A questionnaire was sent to all GPs in three London boroughs. It measured GPs' beliefs about their management with respect to provision of information, sharing decisions and following 'best' practice for depression, as defined by locally adapted guidelines emphasising evidence based and patient centred care. It also inquired about their perceived confidence, knowledge, enjoyment and plans for changing their practice or committing time to change with respect to depression. Of 274 questionnaires, 428 were returned. GPs believed they normally explained treatment options well and involved patents in decision making but did not always consider referring to counselling or question about suicide risk. They rarely provided written information about depression. 45% reported aiming for less than 100mg doses of tricyclic antidepressants. A significant minority admitted to low confidence, satisfaction and enjoyment when managing depression. GPs potentially needing support were no more likely to be able to commit time to change than those with no self reported support needs. This paper shows that GPs, who were generally confident about depression management, believed they involved patients in decision making; it is likely that the extent to which this occurred has been overestimated. The results support other studies by showing a reluctance amongst GPs to follow guidance to prescribe tricyclic antidepressants in higher doses and confirms that depression is not usually a priority for postgraduate training. However, it was possible to identify a group of GPs whose patients could benefit if they accepted support. The implications for providing training to GPs about the management of depression are discussed.