[The therapeutic alliance in the initial stages of the management of depression by the general practitioner]. / L'alliance thérapeutique au début d'une prise en charge pour dépression par le généraliste.

In the field of depression, good initial management is crucial for the subsequent treatment. A relationship based on trust is essential. This can be of various types: there is no consensus on what is the "best" type of relationship. General practitioners diagnose more than two-thirds of depression and write out more than one third of prescriptions for antidepressors. Physicians are faced with various problems in the management of depressed patients: lack of time during the consultation, insufficient training in depression and its treatment, absence of somatic markers, fear of suicide risks... To specify the problems and elaborate responses, this survey assessed, mirror-wise, the point of view of the patient and that of the physician, the feelings regarding the pathology and its treatment, during consultations when the physician is confronted with a depression syndrome. Patient anonymousness was guaranteed by the use of a ballot box and sealed envelopes. In both parties, the survey explored the perception and experience of the pathology, the patient-physician relationship, and the history and perception of the initial consultations. Eligible patients were those who had been diagnosed with depression by the general practitioner and who had been informed of this during the past three months. Based on this information, and other than the data regarding the pathology, the procedure for establishing the diagnosis, the conditions in which the diagnosis was announced and the treatment measures, a characterisation of the alliance between the patient and the physician was established based on the combination of the patients' and physicians' data. Homogenous patient-physician groups were thus identified using multiple component factorial analysis followed by mixed classification. This methodology identified types of patient-physician binomials according to the nature of their alliance (independent of any "doctor effect"): a clinical alliance, a united alliance, an alliance based on sense, and a difficult alliance.