Barriers to psychotherapy among depressed and nondepressed primary care patients
Tóm tắt
Background: Most primary care patients who experience depression state that they would prefer psychotherapy over antidepressant medications. However, when referrals for psychotherapy are made, only 20% ever follow up, and of these, half drop out of treatment. This suggests that there are substantial barriers to accessing psychotherapy.Purpose: The aim of this study was to investigate perceived barriers to psychotherapy in a sample of primary care patients and to test the hypothesis that these barriers would be more common among patients with depression.Methods: Patients were sampled from a large primary care service and mailed a survey. The survey included evaluation of barriers using items identified in previous published research, which we refer to as Perceived Barriers to Psychotherapy (PBP). Depression was measured using the Perceived Health Questionnaire-9 (PHQ-9).Results: Of the 904 surveys sent, 290 (32.1%) were returned. The PBP produced two factors—practical barriers and emotional barriers—explaining 58.2% of the variance with an internal reliability of α?= .79. Among all patients, 59.5% reported at least one barrier that would make it very difficult or impossible to participate in psychotherapy. Depression was associated with increased frequency of perceived barriers, with 74.0% of depressed patients reporting one or more barriers, versus 51.4% of nondepressed patients (p = .008). One or more perceived practical barriers were reported by 56.6% of the sample, whereas only 11.1% reported perceived emotional barriers. Depression was consistently associated with increased emotional barriers. Practical barriers were not consistently associated with depression but were influenced by history of psychotherapy.Conclusions: The majority of primary care patients surveyed reported one or more perceived barriers that would interfere with or prevent initiation or regular attendance of psychotherapy. Perceived barriers were more common among depressed than nondepressed patients making depression both an indicator for psychotherapy and a barrier to receiving it.
Tài liệu tham khảo
Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.Archives of General Psychiatry. 1994,51:8–19.
Kessler RC, Berglund P, Demler O, et al.: The Epidemiology of Major Depressive Disorder: Results from the National Comorbidity Survey Replication (NCS-R).Journal of the American Medical Association. 2003,289:3095–3105.
Brody DS, Khaliq AA, Thompson II TL: Patients’ perspectives on the management of emotional distress in primary care settings.Journal of General Internal Medicine. 1997,12:403–406.
Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB: Treatment preferences among depressed primary care patients.Journal of General Internal Medicine. 2000;15:527–534.
Bedi N, Chilvers C, Churchill R, et al.: Assessing effectiveness of treatment of depression in primary care. Partially randomised preference trial.British Journal of Psychiatry. 2000,177:312–318.
Priest RG, Vize C, Roberts A, Roberts M, Tylee A: Lay people’s attitudes to treatment of depression: Results of opinion poll for Defeat Depression Campaign just before its launch.British Medical Journal. 1996,313:858–859.
Churchill R, Khaira M, Gretton V, et al.: Treating depression in general practice: Factors affecting patients’ treatment preferences.British Journal of General Practice. 2000,50:905–906.
Weddington Jr. WW: Adherence by medical-surgical inpatients to recommendations for outpatient psychiatric treatment.Psychotherapy and Psychosomatics. 1983,39:225–235.
Wierzbicki M, Pekarik G: A meta-analysis of psychotherapy dropout.Professional Psychology: Research and Practice. 1993,24:190–195.
Wells K, Miranda J, Bauer M, et al.: Overcoming barriers to reducing the burden of affective disorders.Biological Psychiatry. 2002,52:655.
Hollon S, Munoz R, Barlow D, et al.: Psychosocial intervention development for the prevention and treatment of depression: Promoting innovation and increasing access.Biological Psychiatry. 2002,52:610.
Blumenthal R, Endicott J: Barriers to seeking treatment for major depression.Depression and Anxiety. 1996,4:273–278.
Alvidrez J, Azocar F: Distressed women’s clinic patients: Preferences for mental health treatments and perceived obstacles.General Hospital Psychiatry. 1999,21:340–347.
Regier DA, Narrow WE, Rae DS, et al.: The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.Archives of General Psychiatry. 1993,50:85–94.
Burns BJ, Ryan Wagner H, Gaynes BN, Wells KB, Schulberg HC: General medical and specialty mental health service use for major depression.International Journal of Psychiatry in Medicine. 2000,30:127–143.
Kroenke K, Spitzer RL,Williams JB: The PHQ-9: validity of a brief depression severity measure.Journal of General Internal Medicine. 2001,16:606–613.
The MacArthur Foundation’s Initiative on Depression and Primary Care:The MacArthur initiative on depression and primary care at Dartmouth and Duke: Depression management toolkit. Hanover, NH: The MacArthur Foundation, 2004.
Ware JE, Kosinski M, Keller SD:SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston: Health Assessment Lab, 1994.
Mohr DC, Hart SL, Honos-Webb L, et al.: Telephone-administered psychotherapy for depression.Archives of General Psychiatry. 2005,62:1007–1014.
Simon GE, Ludman EJ, Tutty S, Operskalski B, Von Korff M: Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: A randomized controlled trial.Journal of the American Medical Association. 2004,292:935–942.
Yuen EJ, Gerdes JL, Gonzales JJ: Patterns of rural mental health care. An exploratory study.General Hospital Psychiatry. 1996,18:14–21.