Primary care physicians' perceived barriers on the management of depression in China primary care settings.

Abstract

Chinese patients with depression have limited access to mental health specialty care because of myriad barriers at different levels. Recently, there has been increased interest in targeting primary care settings for managing depression, because most depressed individuals visit their primary care physicians (PCPs) during the course of their depressive episodes. The present study examined PCPs' perceived barriers on the management of depression. A total of 295 PCPs completed a 36-item survey by mail. The survey questions included demographics, years in primary care, mental health training experience, and perceived barriers regarding the management of depression in their clinical and current practices. Chi-square and t-test analyses were used to compare the difference of demographic variables between the two districts. For the correlates of PCPs' clinical practices and their perceived barriers, logistic regression models were used. At the practice level, lack of access to mental health specialists (37.8%) was the most commonly reported barrier and at patients' level, reluctance toward diagnosis of depression (34.6%) was the high barrier. Results have indicated that most PCPs (69.2%) felt comfortable discussing psychological issues with patients. Mental health training is significantly related to PCPs' clinical practice. When PCPs perceived moderate to high-level practice level barriers, prescription and referral were mostly preferred. PCPs in China perceived some barriers in the management of depression, but they were open to modifications and enhancement of their skills related to managing depression.