“Gatekeepers” perspective on treatment access for anxiety and depression: A survey of New Brunswick family physicians.
Bibliographic record
Abstract
Family physicians are the professionals most often consulted by Canadians experiencing anxiety and depression. Their referral practices, then, are an important source of access to specialized psychological treatments. However, research on treatment and referral practices in primary care is limited. The present study conducted a survey of 152 Francophone and Anglophone family physicians in New Brunswick on their perceived treatment and referral practice for adults with a clinically significant anxious or depressive condition. Only a minority of physicians routinely refer patients with anxiety or depression for specialized psychotherapy. Many patients are treated solely in the primary care setting with a combination of pharmacotherapy and counselling. The latter tends to take the form of advice giving, even though it meets minimal practice standards in terms of number of sessions. Physicians with more experience are less likely to refer for psychotherapy than physicians with less years of practice. Several recommendations for addressing the treatment gap in anxiety and depression are discussed.Keywords: anxiety, depression, access to treatment, referral rates, primary careResumeLes medecins de famille sont les professionnels les plus souvent consultes par les Canadiens souffrant d'anxiete et de depression. Leurs pratiques de recommandation representent ainsi une source importante d'acces aux traitements psychologiques specialises. La recherche portant sur les pratiques de traitement et de recommandation relatives aux soins de premiere ligne est toutefois limitee. La presente etude resulte d'une enquete realisee aupres de 152 medecins de famille anglophones et francophones du Nouveau- Brunswick afin de connaItre leurs perceptions au sujet des pratiques de traitement et de recommandation chez les adultes souffrant de troubles d'anxiete ou de depression significatifs sur le plan clinique. Seulement une minorite de medecins recommandent leurs patients souffrant d'anxiete ou de depression en psychotherapie specialisee sur une base reguliere.Bon nombre de patients ne sont traites qu'en premiere ligne au moyen de pharmacotherapie couplee a des consultations, lesquelles prennent souvent la forme de simples conseils, meme si cela correspond aux normes de pratique minimales en termes de nombre de seances. Les medecins qui ont plus d'experience sont moins susceptibles de recommander leurs patients en psychotherapie que les medecins qui ont moins d'annees de pratique. Plusieurs recommandations sont proposees pour pallier le manque de traitement des troubles d'anxiete et de depression.Mots-cles : anxiete, depression, acces aux traitements, taux de recommandation, soins de premiere ligne.Anxiety and depressive disorders together account for the highest proportion of mental disorders in Canadian adults, with estimated lifetime prevalence rates of 12.2% for major depressive disorder, 3.7% for panic disorder, and 8.1% for social anxiety disorder (Public Health Agency of Canada, 2006). The annual cost to the Canadian economy for anxiety disorders has been estimated at $65 billion, and it is over $14 billion for depression and general psychological distress (Dupont, Dupont, & Rice, 2002; Stephens & Joubert, 2001). Despite the enormity of this health care problem, only 37.1% of Canadians who met the criteria for an anxiety, mood disorder, or substance dependence consulted with a professional within a 12-month period, most times with a family physician (Public Health Agency of Canada, 2006). This is consistent with worldwide studies showing an even larger treatment gap for anxiety and depression in many developed countries (Kohn, Saxena, Levav, & Saraceno, 2004). Access to psychological treatments, especially evidence-based treatments, is even more limited (Gunter & Whittal, 2010; Shafran et al., 2009). This low treatmentseeking rate is not due to lack of perceived need for care by mental health consumers. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".