Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychiatry Registrars

Kay M Jones,Leon Piterman

doi:10.4236/ojpsych.2014.44037

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.

Highlights

GPs are the most accessible medical resource in the community and are the gatekeepers to other community resources including psychiatrists
All data were collected in Melbourne; a focus group was held with the psychiatry registrars (6 females, 4 males) which lasted approximately one-and-a-half-hours, was audio-taped and transcribed verbatim
Question 2: What is your understanding of other terms? Registrars’ understanding of other terms, viz treatment resistant depression, treatment-refractory depression, treatment-resistant major depressive disorder and major depressive disorder varied with around half indicating they had limited understanding of the terms: “I think we’ve got an enormous problem with semantics” (PR2)

Summary

Introduction

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 joining and completing a five-year training program, which is based around rotations that cover ward rounds and case review in adult, child/adolescent and forensic psychiatry, consultation liaison, and experiences in rural psychiatry, indigenous mental health, psychiatry of old age, addiction, electroconvulsive therapy and psychotherapies [8] [9] This training program provides the trainees with experiences and links to GPs and community services via their rotations in hospitals (public, remote public, private, not-forprofit hospitals) and community settings (public, private, not-for profit community settings, youth custodial facilities, residential facilities and Aboriginal Community Controlled Health Services) [9]

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