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      General practitioners’ views towards management of common mental health disorders: Τhe critical role of continuing medical education

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          Abstract

          Background

          The disability burden of common mental health disorders is enormous and should be faced at the first point of contact in the healthcare system. General Practitioners (GPs) are called to recognize, diagnose, and manage patients with mental health disorders, a task which is not always addressed successfully. The study aims at examining the relationship between mental health education of GPs and self-reported opinions on the care they provide to patients with mental disorders in Greece.

          Methods

          A questionnaire investigating GPs' viewpoints regarding diagnostic methods, referral rates and overall management of patients with mental disorders, and how these are impacted by their education on mental health, was employed, in a randomly selected sample of 353 GPs in Greece. Suggestions and proposals about improvement of ongoing mental health training, along with organizational reforming were also recorded.

          Results

          Received Continuing Medical Education (CME) is characterized as insufficient by 56.1% of the GPs. More than half of the GPs participate in clinical tutorials and mental health conferences once per three years or less. The level of educational score on mental health is associated positively with decisiveness on management of patients and increases self-confidence. A percentage of 77.6% states knowledge of the appropriate treatment and 56.1% agree to initiate treatment without referring to a specialist. However, low to moderate self-confidence about diagnosis and treatment is stated by 47.5%. According to GPs, critical points for improving mental health primary care are the liaison psychiatry and high degree of CME.

          Conclusion

          Greek GPs are calling for focused and continuing medical education, in the field of psychiatry, along with essential structural and organizational reforming of the healthcare system, including an efficient liaison psychiatry.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12875-023-02017-5.

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          Most cited references25

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          Global Burden of Disease and the Impact of Mental and Addictive Disorders

          Jürgen Rehm, Kevin Shield (2019)
          This contribution reviews the newest empirical evidence regarding the burden of mental and addictive disorders and weighs their importance for global health in the first decades of the twenty-first century.
          Article 0 comments Cited 419 times – based on 0 reviews     Review now
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            Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.

            Jose Posada-Villa, Ronny Bruffaerts, Koen Demyttenaere … (2004)
            Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
            Article 0 comments Cited 362 times – based on 0 reviews     Review now
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              Clinical diagnosis of depression in primary care: a meta-analysis.

              Alex J Mitchell, Amol Vaze, Sanjay Rao (2009)
              Depression is a major burden for the health-care system worldwide. Most care for depression is delivered by general practitioners (GPs). We assessed the rate of true positives and negatives, and false positives and negatives in primary care when GPs make routine diagnoses of depression. We undertook a meta-analysis of 118 studies that assessed the accuracy of unassisted diagnoses of depression by GPs. 41 of these studies were included because they had a robust outcome standard of a structured or semi-structured interview. 50 371 patients were pooled across 41 studies and examined. GPs correctly identified depression in 47.3% (95% CI 41.7% to 53.0%) of cases and recorded depression in their notes in 33.6% (22.4% to 45.7%). 19 studies assessed both rule-in and rule-out accuracy; from these studies, the weighted sensitivity was 50.1% (41.3% to 59.0%) and specificity was 81.3% (74.5% to 87.3%). At a rate of 21.9%, the positive predictive value was 42.0% (39.6% to 44.3%) and the negative predictive value was 85.8% (84.8% to 86.7%). This finding suggests that for every 100 unselected cases seen in primary care, there are more false positives (n=15) than either missed (n=10) or identified cases (n=10). Accuracy was improved with prospective examination over an extended period (3-12 months) rather than relying on a one-off assessment or case-note records. GPs can rule out depression in most people who are not depressed; however, the modest prevalence of depression in primary care means that misidentifications outnumber missed cases. Diagnosis could be improved by re-assessment of individuals who might have depression. None.
              Article 0 comments Cited 170 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Michalis Leotsinidis: micleon@upatras.gr
                Journal
                Journal ID (nlm-ta): BMC Prim Care
                Journal ID (iso-abbrev): BMC Prim Care
                Title: BMC Primary Care
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2731-4553
                Publication date (Electronic): 4 March 2023
                Publication date PMC-release: 4 March 2023
                Publication date Collection: 2023
                Volume: 24
                Electronic Location Identifier: 63
                Affiliations
                [1 ]GRID grid.11047.33, ISNI 0000 0004 0576 5395, Lab of Public Health, Medical School, , University of Patras, ; GR-26504 Patras, Greece
                [2 ]Primary Health Care Centre of Kleitoria, Achaia, Greece
                Article
                Publisher ID: 2017
                DOI: 10.1186/s12875-023-02017-5
                PMC ID: 9985274
                PubMed ID: 36870977
                SO-VID: 87ce5619-2240-457d-a8f0-13e81e5d2f58
                Copyright © © The Author(s) 2023
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 10 August 2022
                Date accepted : 23 February 2023
                Funding
                Funded by: University of Patras
                Open Access :

                Open access funding provided by HEAL-Link Greece.

                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2023

                Keywords: common mental disorders,general practitioners,mental health education,primary care,depression,anxiety
                Data availability:
                Keywords: common mental disorders, general practitioners, mental health education, primary care, depression, anxiety

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