• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Jan 1999; 49(438): 17–21.
PMCID: PMC1313311

Sex and attitude: a randomized vignette study of the management of depression by general practitioners.


BACKGROUND: The management and detection of depression varies widely, and the causes of variation are incompletely understood. AIMS: To describe and explain general practitioners' (GPs') current practice in the recognition and management of depression in young adults, their attitudes towards depression, and to investigate associations of GP characteristics and patient sex with management. METHOD: All GP principals in the Greater Glasgow Health Board were randomized to receive questionnaires with vignettes describing increasingly severe symptoms of depression in either male or female patients, and asked to indicate which clinical options they would be likely to take. The Depression Attitude Questionnaire was used to elicit GP attitudes. RESULTS: As the severity of vignette symptoms increased, GPs responded by changing their prescribing and referral patterns. For the most severe vignette, the majority of GPs would prescribe drugs (76.4%) and refer the patient for further help (73.7%). Male and female patients were treated differently: GPs were less likely to ask female patients than male patients to attend a follow-up consultation (odds ratio [OR] = 0.55), and female GPs were less likely to refer female patients (OR = 0.33). GPs with a pessimistic view of depression, measured using the 'inevitable course of depression' attitude scale, were less willing to be actively involved in its treatment, being less likely to discuss a non-physical cause of symptoms (OR = 0.77) or to explore social factors in moderately severe cases (OR = 0.68). CONCLUSIONS: Accepting the limitations of the method, GPs appear to respond appropriately to increasingly severe symptoms of depression, although variation in management exists. Educational programmes should be developed with the aim of enhancing GP attitudes towards depression, and the effects on detection and management of depression should be rigorously evaluated.

Full Text

The Full Text of this article is available as a PDF (52K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Wright AF. Continuing to defeat depression. Br J Gen Pract. 1995 Apr;45(393):170–171. [PMC free article] [PubMed]
  • Blacker CV, Clare AW. Depressive disorder in primary care. Br J Psychiatry. 1987 Jun;150:737–751. [PubMed]
  • Ormel J, Koeter MW, van den Brink W, van de Willige G. Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry. 1991 Aug;48(8):700–706. [PubMed]
  • Lloyd KR, Jenkins R, Mann A. Long-term outcome of patients with neurotic illness in general practice. BMJ. 1996 Jul 6;313(7048):26–28. [PMC free article] [PubMed]
  • Whitehouse CR. A survey of the management of psychosocial illness in general practice in Manchester. J R Coll Gen Pract. 1987 Mar;37(296):112–115. [PMC free article] [PubMed]
  • Goldberg DP, Blackwell B. Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J. 1970 May 23;1(5707):439–443. [PMC free article] [PubMed]
  • Marks JN, Goldberg DP, Hillier VF. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med. 1979 May;9(2):337–353. [PubMed]
  • Howe A. "I know what to do, but it's not possible to do it"--general practitioners' perceptions of their ability to detect psychological distress. Fam Pract. 1996 Apr;13(2):127–132. [PubMed]
  • Boardman AP. The General Health Questionnaire and the detection of emotional disorder by General Practitioners. A replicated study. Br J Psychiatry. 1987 Sep;151:373–381. [PubMed]
  • Kerr M, Blizard R, Mann A. General practitioners and psychiatrists: comparison of attitudes to depression using the depression attitude questionnaire. Br J Gen Pract. 1995 Feb;45(391):89–92. [PMC free article] [PubMed]
  • Dale J, Middleton H. Factors influencing general practitioners' management of psychosocial and physical problems: a study using case vignettes. Br J Gen Pract. 1990 Jul;40(336):284–288. [PMC free article] [PubMed]
  • McLoone P. Suicide and deprivation in Scotland. BMJ. 1996 Mar 2;312(7030):543–544. [PMC free article] [PubMed]
  • Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986 Mar;42(1):121–130. [PubMed]
  • Priest RG. A new initiative on depression. Br J Gen Pract. 1991 Dec;41(353):487–487. [PMC free article] [PubMed]
  • Paykel ES, Priest RG. Recognition and management of depression in general practice: consensus statement. BMJ. 1992 Nov 14;305(6863):1198–1202. [PMC free article] [PubMed]
  • Kendrick T. Prescribing antidepressants in general practice. BMJ. 1996 Oct 5;313(7061):829–830. [PMC free article] [PubMed]
  • Williams JB, Spitzer RL, Linzer M, Kroenke K, Hahn SR, deGruy FV, Lazev A. Gender differences in depression in primary care. Am J Obstet Gynecol. 1995 Aug;173(2):654–659. [PubMed]
  • Wright AF. Psychological distress: outcome and consultation rates in one general practice. J R Coll Gen Pract. 1988 Dec;38(317):542–545. [PMC free article] [PubMed]
  • Cartwright A. Professionals as responders: variations in and effects of response rates to questionnaires, 1961-77. Br Med J. 1978 Nov 18;2(6149):1419–1421. [PMC free article] [PubMed]
  • McAvoy BR, Kaner EF. General practice postal surveys: a questionnaire too far? BMJ. 1996 Sep 21;313(7059):732–734. [PMC free article] [PubMed]
  • Templeton L, Deehan A, Taylor C, Drummond C, Strang J. Surveying general practitioners: does a low response rate matter? Br J Gen Pract. 1997 Feb;47(415):91–94. [PMC free article] [PubMed]
  • Kerwick S, Jones R, Mann A, Goldberg D. Mental health care training priorities in general practice. Br J Gen Pract. 1997 Apr;47(417):225–227. [PMC free article] [PubMed]
  • Gask L, McGrath G, Goldberg D, Millar T. Improving the psychiatric skills of established general practitioners: evaluation of group teaching. Med Educ. 1987 Jul;21(4):362–368. [PubMed]
  • Hannaford PC, Thompson C, Simpson M. Evaluation of an educational programme to improve the recognition of psychological illness by general practitioners. Br J Gen Pract. 1996 Jun;46(407):333–337. [PMC free article] [PubMed]
  • Howe A. Detecting psychological distress: can general practitioners improve their own performance? Br J Gen Pract. 1996 Jul;46(408):407–410. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...