Review examines how well GPs treat anxiety, depression or substance abuse

Jul 18 2007

When patients have psychosocial problems such as anxiety, depression or substance abuse, a general practice doctor is often the first healthcare professional they see.

A new review of studies examines how well GPs treat these conditions.

“We found no strong evidence for either the effectiveness (or ineffectiveness) of the psychosocial interventions by GPs,” wrote the review team from the Netherlands. “Of the interventions reviewed, problem-solving treatment for depression seems the most promising tool for GPs, although its effectiveness in daily practice remains to be seen.”

Problem-solving treatment is a type of talk therapy. The goal is to help patients understand that their symptoms are caused by everyday problems and to teach them ways to tackle these problems.

The review appears in the latest issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“Many patients visit their GP because of problems that are psychosocial in origin,” according to the team led by Marcus Huibers, an assistant professor in the Department of Clinical Psychological Services at Maastricht University. “Consequently, GPs could benefit from tools to help those patients.”

In the United States, a patient's primary care physician is often a GP — generally a doctor who specializes in family medicine or general internal medicine.

The reviewers looked at 10 studies on the effectiveness of interventions by GPs for depression, smoking cessation, alcohol abuse and unexplained fatigue as well as somatization disorder, where patients have chronic, unexplained physical symptoms caused by psychological problems.

Except for problem-solving treatment for major depression, the evidence on the effectiveness of GP care for psychosocial health complaints was either limited or conflicting, the review found. However, insufficient evidence does not mean that primary care physicians should be discouraged from tending to their patients' mental health needs, the review authors said.

“The main message is that there is no reason not to start treatment for these problems with your GP,” said Nancy Stevens, M.D., professor of family medicine at the University of Washington School of Medicine in Seattle. “There is nothing in the review that says we should change what we are doing, nor are there any indications that what we are doing is harmful.”

Many GP office visits are for complaints that are psychosocial in nature and not always medically based, says Betsy Pedersen, Ph.D., assistant clinical professor of family medicine at the University of North Carolina School of Medicine in Chapel Hill.

“I would tell the patient to continue what they have always done and bring their concerns to their GP,” Pedersen said. “The GP will have training in psychosocial problems, is well qualified to know what other resources are available and will be able to help the person link up with those resources if they are needed.”

“For most psychosocial interventions, the relationship with the provider is critical,” Stevens said. “The really important message from this review is that patients need to develop a relationship with a health care provider who really knows them, so that when they have psychosocial issues there is someone available who they trust and who knows how to help them through it.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.