Attitudes of Israeli Primary Care Physicians towards Mental Health Care/Commentary - Attitudes
Goldfracht, Margalit, Shalit, Chani, Peled, Ofra, Levin, Diane, Munitz, Hanan, The Israel Journal of Psychiatry and Related Sciences
Abstract: Rates of depression and anxiety are increasing all over the world in developed and developing countries as well and Israel is no exception to this trend. People suffering from depression and anxiety disorders tend not to turn for professional help to mental health clinics but to primary care. This cross-sectional study examines the attitudes and barriers of primary care physicians in the southern region of Israel toward providing care for depression and anxiety in their practices. In 2002 we sent a questionnaire concerning attitudes and barriers toward depression and anxiety to 99 primary care physicians from 14 primary care clinics with a response rate of 67.7% (67 physicians); 80.6% of the participants agreed with the statement that depression and anxiety are frequent problems in primary care and they should be treated in primary care clinics, but 37.3% reported to have little interest in treating mental disorders, 47.7% thought depression and anxiety should be treated in mental health clinics; 43.3% of the participants declared that they experienced a personal difficulty in taking care of patients with depression and anxiety, and 85% identified time constraint as a major barrier to care of depression and anxiety in primary care. This study suggests that in order to improve treatment of depression and anxiety in primary care, there is a need for a change of attitudes of the primary care providers.
Rates of depression and anxiety are increasing all over the world. According to WHO reports there is little difference in the prevalence of mental health impairments between developed and developing countries (1). Of the population in U.S.A., 5.1% reported mental health problems, mainly depression and anxiety (2). In Europe the general prevalence of depression was found to be about 5% (3). Depression is expected to be second to heart disease as a source of the global burden of disease by the year 2020 (4). Among patients attending primary care clinics the prevalence of mental health disorders is even higher. In Sweden 30.2% of patients visiting primary care reported depressive symptoms (5), while 16.4% reported anxiety symptoms in Denmark (6). Twenty-five to 50% of visitors in primary care clinics have some kind of mental health impairment (6). It is reasonable to assume that Israel is no exception to this trend.
Schwartzman et al. found that 5.9% of primary care patients in southern Israel suffered from major depression and 15.9% had depressive symptoms. The direct medical costs of patients with major depression were three times higher than the general population and the costs of people with depressive symptoms were higher by 25% (7). We found no Israeli study on anxiety disorders, but we may assume that its prevalence is similar to other countries.
People suffering from mild depression and anxiety disorders tend not to turn for professional help to mental health clinics (8). An Australian study has found that 49% of persons with depressive disorder had consulted their GP for mental health problems in the last year compared with 12% who consulted a psychiatrist (9).
Primary care physicians are therefore the main health care providers patients are willing to approach for treatment of their mental health problems. Nevertheless, the literature reports underdiagnosis and under-treatment of mental health problems in primary care (10).
Clalit Health Services (CHS), Israel's largest Health Maintenance Organization, decided to embark on a long-term program for improving the care of depression and anxiety in primary care. As a first step in the program our aim was to identify the attitudes and barriers in the way of primary care physicians treating depression and anxiety in their clinics. This is a cross-sectional study which examines the knowledge, attitudes and barriers of primary care physicians toward providing care for depression and anxiety in their practices.
The research tool: On the basis of a literature search (11 -15) we constructed a questionnaire with face validity. …