Improving care in depression: qualitative study investigating the effects of using a mental health questionnaire.

BACKGROUND: Depression has major health and social consequences. There is concern that general practitioners (GPs), who manage most depression in primary care, are reluctant to use assessment tools such as questionnaires that might improve diagnosis and management. A Cochrane systematic review has recommended qualitative exploratory studies to explore the impact of questionnaires on GP management. AIM: To identify effects of using mental health questionnaires on views of GPs managing depression, and how this might influence patient care. DESIGN: Qualitative, formative evaluation using principles of grounded theory in analysis of semi-structured interviews and focus groups before and after introducing the mental health questionnaire. SETTING: Four practices in South London. PARTICIPANTS: Twenty GPs, of whom four contributed to the pilot only, and 16 completed the main study. MAIN OUTCOME MEASURE: Identification of changes in GP views as a result of using the questionnaire with patients. RESULTS: Three themes emerged from analysis of GP views on managing depression: control and responsibility; the doctor-patient relationship, and support for the doctor. These were influenced by GPs' experience (years in practice), and perceived time spent dealing with depression (involvement). Use of the questionnaire enabled more experienced GPs to relinquish control, encourage patient involvement, and offer alternative sources of help. They felt less responsible for overall care. Less experienced, and less involved GPs found questionnaires supportive through increasing their confidence in asking difficult questions, and were encouraged to look for depression, which they might previously have avoided. CONCLUSIONS: Using mental health questionnaires helped GPs feel more confident in detecting and managing depression, and there was greater willingness to use questionnaires than found in previous studies. Most GPs sought reduced responsibility in ongoing care, using questionnaires to involve patients and pass responsibility to them or other agencies.