Physicians' attitudes toward integrating consultation-liaison psychiatric services in four major general hospitals in Tehran

Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review

“…In a 2015 survey by Hamdieh and team based in Iran, hospital doctors who had positive attitude towards their CLP service were more comfortable in making psychiatric referrals [41]. This result was supported by a one year single-site study of a German CLP service.…”

“…Internal medicine speciality [33, 40, 52–55]2. Positive attitude towards CLP [35, 41]3. Discomfort in competency assessment and management [57]Decrease CLP referral1.…”

“…Organic psychosis and previous psychiatric contact associated with decreased referral.Caplan et al 2008 [38]USN/AOpinion pieceWork pressure suggested with increased CLP referralsWood & Bisson 2004 [39]UK, maxillofacial surgery unit58 patients with cancers of head and neckSubjective reporting of experience with mental health nurse liaisonIncreased referrals suggested with use of mental health nurse liaison.Cohen-Cole et al 1982 [40]US, North Carolina Memorial Hospital407 hospital doctors (34 % response rate)37 item questionnairePhysicians in internal medicine and family medicine tend to recognise patients with more psychological issues.Most hospital doctors are comfortable with managing psychiatric illness.Lin et al 2011 [52]Taiwan, general hospital111 obstetric and gynaecologic patientsRetrospective chart reviewLow referral rates from obstetric and gynaecologic department.Ni Mhaolain et al 2008 [53]Ireland, general hospital96 surgical patientsProspective evaluation of anxiety and depression in surgical patientsHigh prevalence of depression and anxiety in surgical patients.Balestrieri et al 2002 [54]Italy, general hospital1039 general inpatientsCross sectional investigation of prevalence of depression among hospital patientsIdentification of depression by hospital doctors in one third of all cases.Fauman 1983 [55]US, private urban hospital265 hospital doctors (41.9 % response rate)66 item questionnaireInternists are more willing to refer suicidal attempts than surgeons. Internists are more willing to ask for consultations than surgeons for all other mental health conditions.Hamdieh et al 2015 [41]Iran, Tehran, general hospital300 non-psychiatric doctors (64.3 % response rate)8 item questionnaireHospital doctors were more comfortable requesting for psychiatric consultations than managing psychiatric conditions themselves.Jourdan & Glickman 1991 [57]US, general hospital380 psychiatric referralsRetrospective chart reviewHigh referral rates for determination of competency. Fear of medico-legal consequences and referrer’s anxiety suggested as reasons for referral rates.Cepoiu et al 2008 [42]N/A36 articles (comprising of 50935 inpatients)Meta-analysis of recognition of depression in inpatients by non-psychiatric doctorsSensitivity was found to be 36.4 % and specificity was 83.7 %Clarke et al 1995 [43]Australia...…”

Relationship between physicians' perceived stigma toward depression and physician referral to psycho‐oncology services on an oncology/hematology ward

“…Univariate analysis showed that physicians' age was related to physician referral and real referral to psycho‐oncology services, and that physicians' gender was related to physician referral, but these relations failed to withstand multivariate analysis. In a previous study, physicians' age and gender did not influence attitudes toward psychiatric consultation . The present study is limited on this count because only 14 physicians were enrolled and all were residents.…”

“…Overall median age was 29 years (range, 27-34 y), and median work experience was 2 years (range, 1.5-3.5 y). Mean physicians' PDD scores were 34.57 (SD = 5.3; range, [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Total PDD scores were not found to be dependent on age, gender, or work experience.…”