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:
- 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.
- 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]