This is the first report in Japan to present the attitudes of non-psychiatric doctors towards depression using the DAQ. Most non-psychiatric doctors agreed with Factor I, “Depression should be treated by psychiatrists,” which contained the items “Working with depressed patients is heavy going” (Item 13), “If depressed patients need antidepressants, they are better off with a psychiatrist than with a general practitioner” (Item 17), and “Psychotherapy for depressed patients should be left to a specialist” (Item 19). This suggests that most non-psychiatric doctors considered depression care to be beyond the scope of their duties.
In Japan, doctors have specialties and their role is to treat illnesses within their specialty. Given that depression is prevalent even in specialty clinics for physical illness [6
], non-psychiatric doctors need to appropriately manage depressed patients. However, there is no model for depression care in Japan, such as the stepped-care model in the UK National Institute for Clinical Excellence (NICE) guidelines, which recommends that GPs and other members of the primary care team identify depressed patients and are actively involved in depression management [16
]. Non-psychiatric doctors in Japan may think that depression should be treated by psychiatrists because there is no clear definition of their role in depression care in the Japanese medical system.
None of the non-psychiatric doctors in this study were comfortable dealing with the needs of depressed patients (Item 9). Furthermore, more than 50
% of the non-psychiatric doctors thought that the number of depressed patients has increased (Item 1). These results suggest that depression care is becoming an increasingly heavy burden for non-psychiatric doctors in Japan. It is of interest that most of the non-psychiatric doctors thought that nurse support was useful in depression care (Item 12): this suggests that cooperation between non-psychiatric doctors and other professionals, such as nurses and psychiatrists, can promote depression care. Collaborative and stepped-care models [16
], in which various professionals cooperate with and provide support to non-psychiatric doctors, may be candidates for appropriate depression care models in Japan.
The non-psychiatric doctors in this study were likely to recognize the importance of depression care. However, they considered this to be beyond their role. This suggests that targeted educational interventions must address motivation for non-psychiatric doctors to play a role in depression care. Promoting their self-efficacy may help motivate them and facilitate their participation in caring for depressed patients. At the same time, a system that reduces the additional burden on non-psychiatric doctors may remove their implicit hesitation to perform screenings to identify depressed patients; this may be achieved by easier referral and improved collaboration with psychiatrists, and by developing the role of nurses in this area.
Use of the DAQ enables us to discuss differences between the attitudes of non-psychiatric doctors in Japan and those of GPs in the UK [7
]. In Japan, many non-psychiatric doctors agreed with “If depressed patients need antidepressants, they are better off with a psychiatrist than with a general practitioner
” (Item 17), whereas British GPs strongly disagreed with this item. This underscores the notion that Japanese non-psychiatric doctors do not recognize depression care as their role, whilst British GPs do. This difference may be due to differences in medical systems, such as the primary care system, between Japan and the UK. Japanese non-psychiatric doctors may also lack confidence in treating depressed patients by themselves, and prefer to refer patients to professionals, such as psychiatrists.
Many non-psychiatric doctors in Japan disagreed with “Most depressive disorders seen in general practice improve without medication
” (Item 3), although British GPs generally agreed with this item [7
]. Japanese non-psychiatric doctors may think medication is essential for treating depressed patients, whilst British GPs may be familiar with approaches other than antidepressants, such as cognitive behavioral therapy. Differences in knowledge about clinical outcomes of depression and effective treatment modalities may explain the difference in results for Item 3.
We compared the Japanese three-factor model derived in the present study with that of the three-factor model derived from factor loading using Glasgow GPs’ attitudes reported in a previous study [9
]. The model derived from Glasgow study did not fit the Japanese non-psychiatric doctors’ attitude. It is suggested that Japanese non-psychiatric doctors’ attitude would be different from GPs in Glasgow. Similarly, we compared the Japanese three-factor model with that of the four-factor model derived from factor loading using other British GPs’ attitudes reported in a previous study [7
]. Factor I derived from Japanese non-psychiatric doctors (Japanese Factor I), “Depression should be treated by psychiatrists,
” shared two items (13 and 19) with Factor II derived from British GPs (British Factor II), “Professional unease.
” Likewise, Japanese Factor III, “Prejudice regarding depression etiology and pathology,
” shared two items (8 and 10) with British Factor III, “Inevitable course of depression,
” which also included Item 17, “If depressed patients need antidepressants, they are better off with a psychiatrist than with a general practitioner
British Factor I, “antidepressants/psychotherapy,” included variables related to the role and relative effectiveness of antidepressants and psychotherapy in depression treatment, and included Items 3, 4, 7, 16, 18, and 20. There was no similar factor in the Japanese factor model, and items 3, 4, 18, and 20 were not included in any of the factors derived from Japanese non-psychiatric doctors. It appears that Japanese non-psychiatric doctors might not share a concept similar to that expressed by British Factor I, which may indicate that Japanese non-psychiatric doctors have limited knowledge of the roles and effectiveness of different depression treatments. Educational opportunities will be needed to promote the acquisition of knowledge on antidepressants and psychotherapy.
The present study has the following limitations. First, the sampling process, sample size, and response rate may have biased the results. Therefore, the generalizability is a major limitation. Second, we used the DAQ, which was developed in the UK where a medical system and culture are different from Japan. Third, there may be limitations with the validity of the DAQ as shown by various factor structures previously reported [15
]. In addition, the three major factors obtained in this study accounted for only 34.3
% of the total variance. A questionnaire tailored to the Japanese medical system and culture may need to be developed in the future.