Abstract
BackgroundDepression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. The objectives of this study were therefore to describe GPs’ practices with people experiencing work disability due to depressive disorders and explore how GPs’ work context may impact on their practices.MethodsWe conducted semi-structured individual interviews with 13 GPs and six mental healthcare professionals in two sub-regions of Quebec. The sub-regions differed in terms of availability of specialized resources offering public mental health services. Data were anonymized and transcribed verbatim. Thematic analysis was performed to identify patterns in the GPs’ practices and highlight impacting factors in their work context.ResultsOur results identified a set of practices common to all the GPs and other practices that differentiated them. Two profiles were defined on the basis of the various practices documented. The first is characterized by the integration of the RTW goal into the treatment goal right from sickness certification and by interventions that include the workplace, albeit indirectly. The second is characterized by a lack of early RTW-oriented action and by interventions that include little workplace involvement. Regardless of the practice profile, actions intended to improve collaboration with key stakeholders remain the exception. However, two characteristics of the work context appear to have an impact: the availability of a dedicated mental health nurse and the regular provision of clinical information by psychotherapists. These conditions are rarely present but tend to make a significant difference for the GPs.ConclusionsOur results highlight the significant role of GPs in the prevention of long-term work disability and their need for support through the organization of mental health services at the primary care level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0459-2) contains supplementary material, which is available to authorized users.
Highlights
Depression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW)
We ensured the credibility of our findings in two ways: first, by gaining knowledge of the GPs’ practice environment through the interviews we conducted with mental healthcare professionals and through the documents we collected; and second, by obtaining comments from GPs during a meeting held in each region, where we presented our preliminary findings to a group of 10 to 15 GPs from among those whom we had interviewed during our study
Overall, our results showed that all the GPs who participated in the study were concerned by the RTW of their patients with mental health problems, and revealed variations in how this concern is reflected in their practices
Summary
Depression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. It is estimated that, in Canada, over 10 % of the labour force suffers from at least one mental health disorder [3], which can affect their work participation [4, 5] and result in significant costs for society. The costs are financial and human and social, arising from consequences such as isolation and secondary anxiety from apprehension about returning to work and dealing with co-workers’ reactions [8]
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