Improving the recognition and management of depression - Is there a role for physician education?

BACKGROUND. Many patients who visit primary care physicians suffer from dep ression, but physicians may miss the diagnosis or undertreat these patients . Improving physicians' communication skills pertaining to diagnosing and m anaging depression may lead to better outcomes. METHODS. We performed a randomized controlled trial involving 49 primary ca re physicians to determine the effect of the Depression Education Program o n their knowledge of depression and their behavior toward depressed patient s. After randomization, physicians in the intervention group completed the Depression Education Program, which consists of 2 4-hour interactive worksh ops that combine lectures, discussion, audiotape review, and role-playing. Between sessions, physicians audiotaped an interview with one of their pati ents. Two to 6 weeks following the intervention program, physicians completed a k nowledge test and received office visits from 2 unannounced people acting a s standardized patients with major depression. These "patients" completed a checklist and scales. Logistic and linear regression were used to control for sex, specialty, and suspicion that the patient was a standardized patie nt. RESULTS. For both standardized patients, more intervention physicians than control physicians asked about stresses at home, and they also scored highe r on the Participatory Decision-Making scale. During the office visits of o ne of the standardized patients, more intervention physicians asked about a t least 5 criteria for major depression (82% and 38%, P = .006), discussed the possibility of depression (96% and 65%, P = .049), scheduled a return v isit within 2 weeks (67% and 33%, P = .004), and scored higher than control physicians on the Patient Satisfaction scale (40.3 and 35.5, P = .014). CONCLUSIONS. The Depression Education Program changed physicians' behavior and may be an important component in the efforts to improve the care of dep ressed patients.