The Management of Depression in Patients With COPD: A Postal Survey of General Practitioners

Abstract

PURPOSE: Depression is common in patients with chronic obstructive pulmonary disease (COPD). Untreated depression leads to poor compliance with medical treatment and increases health care utilization. We examined the management of depression by general practitioners (GPs), using case vignettes, in patients with COPD, severe osteoarthritis and depressive symptoms alone. METHODS: We surveyed a random sample of general practitioners (N=3,956) in England using a postal questionnaire. The questionnaire explored how GPs would approach the management of emotional distress in patients with and without a chronic condition and gauged their views of and experiences with depression in patients with COPD. RESULTS: 864 completed responses were received (22%). In the vignettes, a significantly greater percentage of GPs reported that they would explore or offer the diagnosis of depression in a patient with COPD (95.4%) compared with patients with either severe osteoarthritis (88.3%) or depressive symptoms alone (86.3%). In each case, the vast majority of GPs reported that they would explore a diagnosis of depression using a clinical diagnostic tool. The preferred method of treatment, if offered, in all three cases was a combination of anti-depressant drugs and psychological therapy. GPs endorsed the importance of routinely screening for depression in patients who have COPD and acknowledged that depression impairs patient self-management of COPD. CONCLUSION: GPs in England were able to diagnose depression and plan appropriate treatment strategies in patients with chronic diseases. GPs believe depression interferes with patient self-management of COPD. CLINICAL IMPLICATIONS: Recognition of depression is the first step in its management, a very important step in light of general practitioners near universal agreement that depression impairs the self-management of other chronic conditions.