Recognition and treatment of depressive disorders and anxiety disorders in family practice is not always in line with current medical standards. Intervention studies to improve the standard of care- focussing on education, dissemination and implementation of guidelines and use of screening instruments- are not particularly encouraging especially regarding patient outcome. Next to benefits of the programs we assumed that such interventions insufficiently match with the problems experienced by family physicians (FPs). Focus group discussions with FPs were held to explore and analyse the problems FPs encounter and to get sight the solutions they bring forward.
Depressive and anxiety disorders are the most common mental health problems in the population, with a prevalence of 4% respectively 5 – 10%, causing burden to patients and society [1, 2]. Both disorders are often co morbid and form a common reason for consultation in family practice [2, 3].
When compared to psychiatric interviews and current guidelines, underrecognition and sub-optimal treatment are reported; in just over half of patients with a major depressive disorder in family practice the diagnosis 'depression' is made, a quarter of them is prescribed an antidepressant subsequently which is, often in a low doses for a too short period of time [3–5]. For a number of patients better recognition and treatment can probably improve their health status . However, there are indications that the labelling of patients' problems in terms of a disorder is not always important for successful management or relapse prevention. Although there is a relative lack of primary care studies, this may indicate that there is still substantial room for improvement of patients' outcome in depression. The same might be true for anxiety disorders .
Recently, the effects of different interventions on the detection, management and outcome of depression and anxiety in family practice were assessed systematically [9, 10]. Only interventions that combined strategies of clinician and patient education, nurse case management, enhanced support from specialist services and monitoring of drug compliance showed a positive effect but only of short duration [9, 10]. We suppose that other barriers than knowledge and skills, such as in task perception, attitudes or interview-style, play a role in FPs recognition of depressive and anxiety disorders as well as patient factors and organisational barriers [11–13]. It is interesting that none of the studies included in the review, though all directed at the quality of care of depression, actually addressed problems FPs may encounter in recognising, diagnosing and treating depression. A qualitative approach seems the best method to analyse FPs' difficulties in this . Some earlier qualitative studies reported problems of FPs in recognition, in differentiating between distress and depressive disorder and addressing depression as a medical/psychiatric disorder. They mainly focussed on depression, and did not address problems in management [15–21].
The aim of the present study was to systematically explore how FPs perceive recognition, diagnosis and management of depressive and anxiety disorders. In addition, we focussed on problems and barriers as experienced by FPs and listed the solutions the FPs proposed to get over these barriers.