General Practitioners' Conceptions of Depressive Disorders: Associations with regional sales of antideprssive drugs

This thesis emanates from considerations about the inter-regional variation of the sales of antidepressive drugs, and how general practitioners may contribute to that variation. The thesis comprises two data collections utilized for five separate studies. The first data set emerges from interviews with seventeen general practitioners and is used for papers I and II. The first paper reports on general practitioners’ conceptions about depressive disorders and the second on their conceptions on factors that have formed their manner of work. The second data set, used for papers III-V, is from a questionnaire survey completed by 317 general practitioners from municipalities with low, average and high sales of antidepressive drugs, respectively. The questionnaire was designed to evaluate the distribution of conceptions revealed by the preceding interview studies. All general practitioners considered that major depression should be treated with antidepressive drugs, but they differed in their views on treatment of not so severe depressive disorders. Some of them displayed difficulties to distinguish the borderline between normal mood reactions on strain and depressive illness. Nearly all attached great importance to their own clinical experience in treatment decisions. A majority also regarded the patient's attitude to the proposed treatment and official treatment guidelines essential. All general practitioners emphasised individual experience as a base for their professional competence. Pharmaceutical companies play a significant role in continuing education on depression. Consequently, much of general practitioners' conceptions of depression treatment emanate from commercial marketing activities. Significant correlations were observed between sales levels of antidepressive drugs and several questionnaire items. High sales levels were associated with conceptions of high effectiveness of antidepressive drugs, small need of psychotherapy, large emphasis on individual experience, a positive opinion of the work with depressed patients, and frequent attendance to activities arranged by drug companies. These associations strongly suggest that the variation in drug sales partly depends on prevailing conceptions and attitudes vis-à-vis depression in the regional groups of general practitioners.