Strategies of German general practitioners in dealing with depressive disorders in primary care patients – a mixed-methods study

Ildikó Gágyor, Sandra Parisi, Laura Hofner

Keywords: depressive disorders, general practice, mixed-methods study design, survey, in-depth interviews

Background:

Depression is a global health issue that challenges general practitioners (GPs) when patients seek medical care. In Germany, psychiatrists and psychotherapists are involved in ambulatory care. In this context, the role of GPs in treating depression is not yet fully understood.

Research questions:

What strategies do GPs use to manage patients with depression? How do GPs perceive their role?

Method:

In January 2021, we sent a survey to 1800 randomly selected Bavarian GPs including an invitation to an in-depth interview (mixed methods design). The 53 items comprised patient management (e.g. consultations, diagnostics, medication) and demographics. Survey data was analysed descriptively. Interviews were analysed using Kuckartz’s content analysis. We employed a triangulation protocol to integrate quantitative and qualitative data.

Results:

Overall, 471 GPs (45.4% female) completed the survey, and 20 participated in an interview. GPs reported referring 6 out of 10 patients to a psychotherapist (mean=6.0, SD=2.4), referring 6 out of 10 to a psychiatrist or neurologist (mean=5.6 SD=2.5), prescribing antidepressants to 5 out of 10 (mean=4.7, SD=2.6) and prescribing herbal drugs to 3 out of 10 (mean=2.8, SD=2.4). Interviews revealed that patients' expectations and concerns guide GPs’ decisions. GPs provide psychosocial support in cases of social burden due to family conflicts and work stress. GPs see themselves as gatekeepers, patients’ advocates, comforters, and problem-solvers, but also describe themselves as sole primary care providers, challenged by limited time and referral options. During the COVID-19 pandemic, GPs noticed rising mental health issues and a decline in supporting healthcare structures. At the same time, GPs had more time for mental health care as they had fewer routine medical tasks to perform.

Conclusions:

Psychosocial guidance is a key strategy for treating depression in primary care. GPs are committed to providing a patient-centered therapeutic approach, yet often feel constrained by the existing healthcare structures.

Points for discussion:

Which GPs’ treatment strategy may serve as a reference point for improving the management of patients with depression?

To what extent do the perceptions of GPs as sole primary care providers in the treatment of depression reflect wider systemic issues within healthcare structures?

What strategies could be implemented to better support GPs in the treatment of depression within primary care?

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