Skip to main content
Top
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Research article

General practitioners' opinions on how to improve treatment of mental disorders in primary health care. Interviews with one hundred Norwegian general practitioners

Authors: Arnstein Mykletun, Ann Kristin Knudsen, Tone Tangen, Simon Øverland

Published in: BMC Health Services Research | Issue 1/2010

Login to get access

Abstract

Background

Improvements in treatment of mental disorders are repeatedly called for. General practitioners (GPs) are responsible for the majority of treatment of mental disorders. Consequently, we interviewed GPs about their opinions on how treatment of mental disorders in primary health care contexts could be improved.

Methods

Among GPs affiliated within the Norwegian reimbursement system, we approached 353, and made contact with 246 GP's. One-hundred of these agreed to participate in our study, and 95 of them expressed opinions on how to improve treatment of mental disorders. The telephone interviews were based on open-ended questions, responses were transcribed continuously, and content analysis was applied. Results are presented both as frequency tables of common responses, and as qualitative descriptions and quotations of opinions.

Results

Nearly all (95%) of the GPs had suggestions on how to improve treatment of mental disorders in primary health care. Increased capacity in secondary health care was suggested by 59% of GPs. Suggestions of improved collaboration with secondary health care were also common (57%), as were improvements of GPs' skills and knowledge relevant for diagnosing and treating mental disorders (40%) and more time for patients with mental disorders in GP contexts (40%).

Conclusions

The GPs' suggestions are in line with international research and debate. It is thought-provoking that the majority of GPs call for increased capacity in secondary care, and also better collaboration with secondary care. Some GPs made comparisons to the health care system for physical disorders, which is described as better-functioning. Our study identified no simple short-term cost-effective interventions likely to improve treatment for mental disorders within primary health care. Under-treatment of mental disorders is, however, also associated with significant financial burdens.
Literature
1.
go back to reference Layard R: Health policy - The case for psychological treatment centres. Br Med J. 2006, 332 (7548): 1030-1032. 10.1136/bmj.332.7548.1030.CrossRef Layard R: Health policy - The case for psychological treatment centres. Br Med J. 2006, 332 (7548): 1030-1032. 10.1136/bmj.332.7548.1030.CrossRef
3.
go back to reference Murray CJ, Lopez AD: Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997, 349 (9063): 1436-1442. 10.1016/S0140-6736(96)07495-8.CrossRefPubMed Murray CJ, Lopez AD: Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997, 349 (9063): 1436-1442. 10.1016/S0140-6736(96)07495-8.CrossRefPubMed
4.
go back to reference Andrews G, Titov N: Depression is very disabling. The Lancet. 2007, 370 (9590): 808-809. 10.1016/S0140-6736(07)61393-2.CrossRef Andrews G, Titov N: Depression is very disabling. The Lancet. 2007, 370 (9590): 808-809. 10.1016/S0140-6736(07)61393-2.CrossRef
5.
go back to reference Wittchen HU, Jacobi F: Size and burden of mental disorders in Europe - a critical review and appraisal of 27 studies. European Neuropsychopharmacology. 2005, 15 (4): 357-376. 10.1016/j.euroneuro.2005.04.012.CrossRefPubMed Wittchen HU, Jacobi F: Size and burden of mental disorders in Europe - a critical review and appraisal of 27 studies. European Neuropsychopharmacology. 2005, 15 (4): 357-376. 10.1016/j.euroneuro.2005.04.012.CrossRefPubMed
6.
go back to reference Sanderson K, Andrews G, Corry J, Lapsley H: Reducing the burden of affective disorders: is evidence-based health care affordable?. Journal of Affective Disorders. 2003, 77 (2): 109-125. 10.1016/S0165-0327(03)00134-4.CrossRefPubMed Sanderson K, Andrews G, Corry J, Lapsley H: Reducing the burden of affective disorders: is evidence-based health care affordable?. Journal of Affective Disorders. 2003, 77 (2): 109-125. 10.1016/S0165-0327(03)00134-4.CrossRefPubMed
7.
go back to reference Simonella L, Marks G, Sanderson K, Andrews G: Cost-effectiveness of current and optimal treatment for adult asthma. Internal Medicine Journal. 2006, 36 (4): 244-250. 10.1111/j.1445-5994.2006.01054.x.CrossRefPubMed Simonella L, Marks G, Sanderson K, Andrews G: Cost-effectiveness of current and optimal treatment for adult asthma. Internal Medicine Journal. 2006, 36 (4): 244-250. 10.1111/j.1445-5994.2006.01054.x.CrossRefPubMed
8.
go back to reference Roness A, Mykletun A, Dahl AA: Help-seeking behaviour in patients with anxiety disorder and depression. Acta psychiatrica Scandinavica. 2005, 111 (1): 51-58. 10.1111/j.1600-0447.2004.00433.x.CrossRefPubMed Roness A, Mykletun A, Dahl AA: Help-seeking behaviour in patients with anxiety disorder and depression. Acta psychiatrica Scandinavica. 2005, 111 (1): 51-58. 10.1111/j.1600-0447.2004.00433.x.CrossRefPubMed
9.
go back to reference Overland S, Glozier N, Krokstad S, Mykletun A: Under-treatment prior to disability pension award for mental illness. The HUNT study. Psychiatric Services. 2007, 58 (11): 3-10.1176/appi.ps.58.11.1479.CrossRef Overland S, Glozier N, Krokstad S, Mykletun A: Under-treatment prior to disability pension award for mental illness. The HUNT study. Psychiatric Services. 2007, 58 (11): 3-10.1176/appi.ps.58.11.1479.CrossRef
10.
go back to reference Zachrisson HD, Rodje K, Mykletun A: Utilization of health services in relation to mental health problems in adolescents: A population based survey. BMC public health [electronic resource]. 2006, 16 (6): 34-10.1186/1471-2458-6-34.CrossRef Zachrisson HD, Rodje K, Mykletun A: Utilization of health services in relation to mental health problems in adolescents: A population based survey. BMC public health [electronic resource]. 2006, 16 (6): 34-10.1186/1471-2458-6-34.CrossRef
11.
go back to reference Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Wang P, Wells KB, Zaslavsky AM: Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine. 2005, 352 (24): 2515-2523. 10.1056/NEJMsa043266.CrossRefPubMedPubMedCentral Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Wang P, Wells KB, Zaslavsky AM: Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine. 2005, 352 (24): 2515-2523. 10.1056/NEJMsa043266.CrossRefPubMedPubMedCentral
12.
go back to reference Kirsch IDBJ, Heudo-Medina TB, Scoboria A, Moore TJ, Johnson BT: Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008, 5 (2): e45-10.1371/journal.pmed.0050045.CrossRefPubMedPubMedCentral Kirsch IDBJ, Heudo-Medina TB, Scoboria A, Moore TJ, Johnson BT: Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008, 5 (2): e45-10.1371/journal.pmed.0050045.CrossRefPubMedPubMedCentral
13.
go back to reference Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet. 2007, 370 (9590): 851-858. 10.1016/S0140-6736(07)61415-9.CrossRef Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet. 2007, 370 (9590): 851-858. 10.1016/S0140-6736(07)61415-9.CrossRef
14.
go back to reference Mykletun A, Bjerkeset O, Dewey M, Prince M, Overland S, Stewart R: Anxiety, depression and cause specific mortality. The HUNT study. Psychosomatic medicine. 2007, 69 (4): 323-331. 10.1097/PSY.0b013e31803cb862.CrossRefPubMed Mykletun A, Bjerkeset O, Dewey M, Prince M, Overland S, Stewart R: Anxiety, depression and cause specific mortality. The HUNT study. Psychosomatic medicine. 2007, 69 (4): 323-331. 10.1097/PSY.0b013e31803cb862.CrossRefPubMed
15.
go back to reference Mykletun A, Bjerkeset O, Øverland S, Prince M, Dewey M, Stewart R: Levels of anxiety and depression as predictors of mortality: the HUNT study. British Journal of Psychiatry. 2009, 195: 118-125. 10.1192/bjp.bp.108.054866.CrossRefPubMed Mykletun A, Bjerkeset O, Øverland S, Prince M, Dewey M, Stewart R: Levels of anxiety and depression as predictors of mortality: the HUNT study. British Journal of Psychiatry. 2009, 195: 118-125. 10.1192/bjp.bp.108.054866.CrossRefPubMed
16.
go back to reference Mykletun A, Overland S, Dahl AA, Krokstad S, Bjerkeset O, Glozier N, Aaro LE: A population-based cohort study of the effect of common mental disorders on disability pension awards. American Journal of Psychiatry. 2006, 163 (8): 1412-1418. 10.1176/appi.ajp.163.8.1412.CrossRefPubMed Mykletun A, Overland S, Dahl AA, Krokstad S, Bjerkeset O, Glozier N, Aaro LE: A population-based cohort study of the effect of common mental disorders on disability pension awards. American Journal of Psychiatry. 2006, 163 (8): 1412-1418. 10.1176/appi.ajp.163.8.1412.CrossRefPubMed
17.
go back to reference Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, Pickering RM, Baker NG, Henson A, Preece J, et al: Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet. 2000, 355 (9199): 185-191. 10.1016/S0140-6736(99)03171-2.CrossRefPubMed Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, Pickering RM, Baker NG, Henson A, Preece J, et al: Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet. 2000, 355 (9199): 185-191. 10.1016/S0140-6736(99)03171-2.CrossRefPubMed
18.
go back to reference Gilbody S, Bower P, Whitty P: Costs and consequences of enhanced primary care for depression - Systematic review of randomised economic evaluations. British Journal of Psychiatry. 2006, 189: 297-308. 10.1192/bjp.bp.105.016006.CrossRefPubMed Gilbody S, Bower P, Whitty P: Costs and consequences of enhanced primary care for depression - Systematic review of randomised economic evaluations. British Journal of Psychiatry. 2006, 189: 297-308. 10.1192/bjp.bp.105.016006.CrossRefPubMed
19.
go back to reference Gilbody S, House AO, Sheldon TA: Screening and case finding instruments for depression. Cochrane Database of Systematic Reviews. 2005, 19; (4): CD002792. Gilbody S, House AO, Sheldon TA: Screening and case finding instruments for depression. Cochrane Database of Systematic Reviews. 2005, 19; (4): CD002792.
20.
go back to reference Gjelsvik B, Swensen E, Hjortdahl P: Allmennlegenes syn på hormonbehandling i og etter overgangsalderen [The general practitioner's view on hormone replacement therapy during and after menopause]. Tidsskrift for Den Norske Lægeforening. 2007, 127: 1500-1503.PubMed Gjelsvik B, Swensen E, Hjortdahl P: Allmennlegenes syn på hormonbehandling i og etter overgangsalderen [The general practitioner's view on hormone replacement therapy during and after menopause]. Tidsskrift for Den Norske Lægeforening. 2007, 127: 1500-1503.PubMed
21.
go back to reference Silverman D: Interpreting Qualitative Data. 2006, London, SAGE Publications, Third Silverman D: Interpreting Qualitative Data. 2006, London, SAGE Publications, Third
22.
go back to reference Neuendorf KA: The content analysis guidebook. 2002, Thousand Oaks, CA, Sage Publications Neuendorf KA: The content analysis guidebook. 2002, Thousand Oaks, CA, Sage Publications
23.
go back to reference Altman DG: Inter-rater agreement. Practical Statistics for Medical Research. 1991, Chapman & Hall/CRC, 403-405. Altman DG: Inter-rater agreement. Practical Statistics for Medical Research. 1991, Chapman & Hall/CRC, 403-405.
24.
go back to reference Rønning M, Sakshaug S, Strøm H, Berg CL, Litleskare I, Blix HS, Granum T: Legemiddelforbruket i Norge 2004 - 2008 [Drug consumption in Norway 2004-2008]. Legemiddelstatistikk. 2009, Oslo: Folkehelseinstituttet Rønning M, Sakshaug S, Strøm H, Berg CL, Litleskare I, Blix HS, Granum T: Legemiddelforbruket i Norge 2004 - 2008 [Drug consumption in Norway 2004-2008]. Legemiddelstatistikk. 2009, Oslo: Folkehelseinstituttet
25.
go back to reference NICE: Depression (amended) Management of depression in primary and secondary care. NICE clinical guideline. 2007, London: National Institue for Health and Clinical Excellence NICE: Depression (amended) Management of depression in primary and secondary care. NICE clinical guideline. 2007, London: National Institue for Health and Clinical Excellence
26.
go back to reference Layard R: Mental Health: Britain's Biggest Social Problem. 2005, London School of Economics Layard R: Mental Health: Britain's Biggest Social Problem. 2005, London School of Economics
27.
go back to reference Gilbody S, Whitty P, Grimshaw J, Thomas R: Educational and organizational interventions to improve the management of depression in primary care - A systematic review. Jama-Journal of the American Medical Association. 2003, 289 (23): 3145-3151. 10.1001/jama.289.23.3145.CrossRef Gilbody S, Whitty P, Grimshaw J, Thomas R: Educational and organizational interventions to improve the management of depression in primary care - A systematic review. Jama-Journal of the American Medical Association. 2003, 289 (23): 3145-3151. 10.1001/jama.289.23.3145.CrossRef
28.
go back to reference Mouland G, Kyvik J: Én time hos psykiater kan være nok [One mutual consultation with patient, psychiatrist and regular general practitioner may be sufficient]. Tidsskrift for Den Norske Lægeforening. 2007, 127: 2810-2812.PubMed Mouland G, Kyvik J: Én time hos psykiater kan være nok [One mutual consultation with patient, psychiatrist and regular general practitioner may be sufficient]. Tidsskrift for Den Norske Lægeforening. 2007, 127: 2810-2812.PubMed
29.
go back to reference Olsson I, Mykletun A, Dahl AA: Recognition and treatment recommendations for generalized anxiety disorder and major depressive episode. A cross-sectional study among general practitioners. The Primary Care Companion. 2006, 8: 340-347. 10.4088/PCC.v08n0604.CrossRefPubMed Olsson I, Mykletun A, Dahl AA: Recognition and treatment recommendations for generalized anxiety disorder and major depressive episode. A cross-sectional study among general practitioners. The Primary Care Companion. 2006, 8: 340-347. 10.4088/PCC.v08n0604.CrossRefPubMed
Metadata
Title
General practitioners' opinions on how to improve treatment of mental disorders in primary health care. Interviews with one hundred Norwegian general practitioners
Authors
Arnstein Mykletun
Ann Kristin Knudsen
Tone Tangen
Simon Øverland
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-35

Other articles of this Issue 1/2010

BMC Health Services Research 1/2010 Go to the issue