Background General practitioners (GPs) provide the most antidepressant prescriptions and psychologist referrals in Australia, yet little is known about how they decide between treatments for depressive symptoms. Aims This study examined the decision cues that GPs use when deciding how to treat depressive symptoms and the meaning they attribute to these associations. Methods Structured interviews were conducted with 16 Australian GPs in a “think-aloud” verbal protocol analysis format. The transcripts were analyzed using content coding and thematic analysis, informed by the dual processes model of decision making. Results Participants associated prescribing antidepressants with severe depressive symptoms, and psychologist referrals were the preferred initial treatment provided patients were willing to engage. Four main themes emerged from the thematic analysis: 1) psychologist as default, 2) the risk is just too high, 3) medication as supplement , and 4) drivers of antidepressants. Contrary to previous findings, participants identified a strong heuristic association between depressive symptoms and psychologist referral. Antidepressant prescription was associated with severe symptoms, higher risk, and a cluster of cues that lead them away from psychologist referral. Conclusions Participants demonstrated an oversensitivity to depressive symptom severity, associating psychologist referrals with subclinical depressive symptoms, and starting antidepressants for suicidal ideation and significant functional decline. Highlights Psychologist referrals were the default preference for GPs when treating depressive symptoms, whereas antidepressants were reserved for patients with elevated risk from severe depressive symptoms and suicidal ideation. Participants’ conceptualization of depression severity was oversensitive compared with treatment guidelines. Contrary to treatment guidelines, GPs in this study demonstrated their discomfort for referring patients with suicidal ideation to a psychologist without initiating antidepressants. GPs should consider whether patients within their mild to moderate assessment range can be treated exclusively with more cost-effective means than psychological therapy such as e-mental health programs, guided self-help, and lifestyle changes alone.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.