Family medicine and internal medicine physicians' attitudes and beliefs about depression: implications for treatment decisions.

Studies have long shown that some patients receive less than optimal care for depression in primary care settings. However, few studies have uncovered factors that predict and explain this deficiency. The authors administered a survey to 408 primary care physicians. They examined how physicians' attitudes (eg, feeling positively or negatively about treating depression in their patients), physicians' beliefs (eg, beliefs about what their patients think and prefer in terms of depression care), and demographic characteristics (independent variables) predicted optimal depression care (dependent variable). Using logistical regression analyses, they identified differences in treatment decisions between family and internal medicine physicians. Physicians' specialty and race (family physicians and white physicians were more likely to prescribe a medication) were unique determinants of whether the physician treated depression by prescribing medication; physicians' specialty and race (family physicians and nonwhite physicians were more likely to provide office-based counseling) were unique determinants of whether the physician treated depression by providing office-based counseling; physicians' beliefs about depression care and physician age were unique statistically significant determinants of whether the physician treated depression by providing a referral to a mental health specialist. These findings help clarify how physicians' specialty and beliefs about depression care influence treatment. In addition, the results in this study suggest that there are differences between family and internal medicine physicians in terms of their practice patterns and beliefs in types of treatment that patients would be willing to receive. Implications for future research on primary care depression treatment are discussed.