TITLE:
Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychiatry Registrars
AUTHORS:
Kay M. Jones, Leon Piterman
KEYWORDS:
Depression, GP, Psychiatry
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.4,
October
15,
2014
ABSTRACT: Introduction: For patients,
GPs are the most accessible medical resource in the community and are the
gatekeepers to other community resources including psychiatrists. Qualifying as
a psychiatrist in Australia involves completing a five-year training program
that includes rotations in hospitals and community settings. The aims of this
research were to 1) explore psychiatry registrars’ perceptions of
difficult-to-treat-depression (DTTD) and 2) what they thought about the GPs’
role in this regard. Methods: A semi-structured interview schedule comprising
six questions was used; 10 psychiatry registrars (6 females, 4 males)
participated in a one-and-half-hour focus group. All were in their final year
of training and undertaking a training post in a public hospital in Melbourne,
Australia. Data were analysed using the Framework Method. Findings: Similar to
GPs and GP trainees, psychiatry registrars’ perceptions and understanding of
DTTD varied. While acknowledging limited
experience in diagnosis and management, issues important to them included the
utility of labels such as DTTD; patients distressed because of another
diagnosis, substance abuse and/or life problems, the importance of accurate
histories and notes, cost and limited availability of services particularly in
the private sector, prescribing regimens, referring to allied health
professionals, and suggesting/prescribing non pharmacological and/or
complementary treatment. Also what was of concern was communication, both
between health professionals and between health professionals and patients.
Consensus was that treating depression in general practice is one of the
hardest things for GPs to manage but there was value in using mental health
plans. Discussion and Conclusion: While this cohort was small in number with
limited experience, this study is the first to contribute to the literature
that provides some insight into psychiatry registrars’ experiences and
perceptions of DTTD. Outcomes may have implications for thepsychiatry training
program and GPs who diagnose and manage patients with mental health problems.