Depression Treatment in Primary Care

W. David Robinson, PhD; Jenenne A. Geske, PhD; Layne A. Prest, PhD; Rachel Barnacle, MS


J Am Board Fam Med. 2005;18(2):79-86. 

In This Article


The charts of 580 patients from 44 FM physicians and 23 IM physicians (27 women and 40 men) were reviewed. The number of eligible depression patients for each physician during the 2-year study period ranged from 1 to 54, with a median of 7.

As hypothesized, the primary care physicians as a whole initiated pharmacological interventions more frequently than any other treatment. In particular, the physicians prescribed pharmacotherapy for an average of 52% of their newly diagnosed depressed patients, combination treatment (pharmacological and psychological) for an average of 27% of the patients, and psychotherapy alone for only 4% of the depression patients (Figure 1).

Mean percentage of patients who were recommended each treatment, by physician specialty.

We found a significant interaction between recommended treatment and physician specialty [F(4, 167) = 3.5, P = .02]. FM practitioners recommended combination treatment significantly more often than IM physicians. On the other hand, FM and IM physicians did not differ in their recommendation of psychotherapy alone, pharmacotherapy alone, counselor-recommended pharmacotherapy, and other treatments.

Consistent with the last hypothesis, female physicians suggested combination therapy significantly more than their male counterparts ( P = .01; Figure 2), whereas male physicians suggested pharmacotherapy significantly more often ( P = .02). Despite these differences, the frequency with which male and female physicians recommended psychotherapy, counselor-recommended pharmacotherapy, or other treatments did not differ significantly.

Mean percentage of patients who were recommended each treatment, by physician gender.

Patient demographics were reviewed to determine whether the patient population differed between FM physicians and IM physicians. We found that the average age of patients of IM physicians was significantly higher (38.9 years, S.D. = 15.1) than that of FM practitioners (35.7 years, S.D. = 13.2; F = 5.8, P = .02). In addition, FM physicians had a higher percentage of female patients (78.6%) than did IM physicians (60.4%; χ2 = 19.5, P < .001). IM physicians had a higher percentage of white patients (94.2%) than FM physicians (80.3%; χ2 = 18.1, P < .001).


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