Patients with chronic physical illness and co-existing psychological morbididty: GPs' views on their role in detection and management

The prevalence of psychiatric co-morbidity (most commonly depression) in the setting of chronic physical illness is higher than it is in the general population. However, it often goes undetected, which has consequences for the patent's quality of life, the outcome of the physical illness and the use of health care resources. The reported failure of general practitioners (GPs) to detect many cases of co-morbid depression and adequately manage the illness is explored from the GPs' perspective. Implications for GP training are discussed. This qualitative study aimed to explore the views and beliefs of GPs about the management of depression in patients with chronic physical illness. A purposive sample of GPs in the Northwest region, who were already involved in undergraduate teaching, was invited to participate in an interview. The interviews were semi-structured, audiotaped and transcribed verbatim. Interviews were continued until category saturation was achieved and the analysed by constant comparison. The data yielded a number of themes that are presented here: Us' views on why people with chronic illness get depressed and their views on why co-morbid depression may go undetected. In addition, we present Us' views on their perceptions of their role in the management of patients with physical and psychiatric morbidity and the adequacy of their training in this area. The GPs were aware of co-morbid psychiatric symptoms in chronic physical illness and alluded to the need for detecting and treating psychological illness appropriately. That the psychological illness may not be detected was perceived by the respondents to be due to many factors, some related to the practitioner and others to the patient. The GPs were resistant to the use of screening instruments and expressed concern about the lack of resources available to this group of patients as well as their lack of training in this area of their work.