The State of Readiness of Lagos State Primary Health Care Physicians to Embrace the Care of Depression in Nigeria

Abstract

Globally there is a huge treatment gap for common mental disorders such as depression. Key to improving access to treatment will be the attitudes held towards depression by those physicians who work in Primary Care. This study aimed to explore Lagos State's Primary Care Physicians' attitudes towards depression and their views regarding their current working practices. A survey of 41 (82%) Primary Care Physicians in Lagos State who, after written consent, completed the Depression Attitude Questionnaire which assessed their knowledge and attitude towards the causes, consequences and treatment of depression. The largest part of the sample (37.5%) estimated that between 5 and 10% of the patients they saw over a 3 months period would have depression while one in four perceived rates of depression seen to be between 31 and 40%. Close to half (40%) of them felt that fewer than 5% of these depressed patients they saw would need antidepressants and a large part (82.9 %) of them agreed that becoming depressed is a way that people with poor stamina deal with life difficulties. About half (41.6%) of them believed it was not rewarding to look after depressed patients. Our study suggests that the current knowledge, attitudes and practices of most Lagos State primary health care physicians may be a barrier to patients with depression accessing appropriate care.

Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial

“…Specifically, RESHAPE participants showed a significant increase in endorsing that depression is treatable by primary care workers and that depression does not need to always be treated with antidepressants. Similar attitudinal and knowledge shifts in relation to the psychosocial context of depression have been found in Nigeria [ 5 ]. In Tunisia, similar shifts were seen in primary care physicians being more comfortable engaging with potential mental health patients, along with an increased knowledge of alternative treatments beyond pharmacology for mental illnesses [ 9 ].…”

“…However, given that PCPs and patients in low- and middle-income countries (LMICs) are accustomed to medications as the standard treatments for non-psychiatric conditions, there is a risk that they favor the adoption of psychiatric medication to the neglect of psychotherapies [ 4 ]. For example, among Nigerian primary care physicians trained in mental health care, 88% endorsed that psychotherapy tended to be unsuccessful among patients with depression, and 85% endorsed that psychotherapy should be left to specialists [ 5 ]. In the same study, 85% supported prescribing anti-depressant medication by non-psychiatric health workers such as PCPs.…”

The influence of primary care physicians’ mental health knowledge, attitudes and self-efficacy on referrals to specialised services: findings from a longitudinal pilot trial

“…For example, studies show that it is common for healthcare professionals to believe that people with mental illness are violent and dangerous, that their condition is a personal or moral fault and that treatment by mental health specialists is preferred. 16,[20][21][22][23][24] This reality might also be reflected in Tunisia: most consultations for mental healthcare continue to be provided in specialised services, 25 despite the uneven distribution of mental health specialists across the country 25 and the ministerial vision of further integrating mental health into primary care settings. 26 Mental health stigma may be instilled in social norms and may help explain, in part, PCPs' choice in referring to specialists versus delivering mental healthcare over the longer term despite the implementation of a mental health training.…”

Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial

“…Stigma among PCPs against people with mental illness has been identified as a contributor to low detection rates in primary care-based mental health services [7][8][9][14][15][16][17][18][19][20][21]. This is because PCPs who stigmatize do not ask about mental illnesses, do not conduct thorough assessments, and do not develop diagnostic competency [15,16,[22][23][24][25]. Therefore, one avenue to improve the accurate detection of mental illnesses among patients in primary care is to integrate stigma reduction when training PCPs.…”