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, Robert Kohn
b
, Itzhak Levav
c
, Francisco Espejo
d
,
Sandra Saldivia
a
, Norman Sartorius
e
a
Departamento de Psiquiatria y Salud Mental, Universidad de Concepcion, Casilla 160-C, Concepcion, Chile
b
Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
c
Ministry of Health, Jerusalem, Israel
d
Servicio de Salud Valparaiso, Valparaiso, Chile
e
Department of Psychiatry, University of Geneva, Switzerland
Received 10 August 2005; received in revised form 10 July 2006; accepted 11 July 2006
Available online 22 August 2006
Abstract
Objectives: This study evaluated the results of a brief 2-day educational training program for Chilean primary care physicians that
measured changes in knowledge, attitudes and practice. This World Psychiatric Association (WPA) program was adopted to
overcome diagnostic and treatment problems that are found among primary care practitioners.
Methods: 37 primary care physicians from two cities in Chile and 2589 patients participated. Physician's knowledge, attitudes and
clinical practice were assessed 1 month prior and 1 month following the training program. In addition, the patients that visited the
clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major
depression checklist at both times.
Results: The results suggested that, with this group of Chilean doctors, the WPA program was effective in improving knowledge
about depression and in changing some disorder-related attitudes. In addition, it had some limited impact on actual clinical practice,
although the rate of diagnosis remained stable and the post-training agreement between physician diagnosis and patient self-report
remained low. The physicians seemed more confident in treating patients and demonstrated increased use of antidepressant agents.
Conclusion: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of
depression, but their competence to play a crucial role remains limited. Further training of primary care physicians to improve the
management of major depression continues to be needed.
2006 Elsevier B.V. All rights reserved.
Keywords: Primary care; Depression; Education; Diagnosis; Attitudes; Knowledge
1. Introduction
Most individuals with depression are seen in the
primary care setting, while only a minority turn to
mental health specialists for help (Hans-Ulrich et al.,
2001). In Chile, over 55% of those who had major
depression go untreated (Vicente et al., 2002). Approxi-
mately 9.2% of Chileans suffer from major depression
during their lifetime (Vicente et al., 2002). These rates
are higher within the primary health care system; in
Santiago, primary care centers 15.8% prevalence rate for
Journal of Affective Disorders 98 (2007) 121127
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