RESUMEN
BACKGROUND: General practitioners (GPs) often manage individuals with work-related common mental disorders (CMD: depressive disorders, anxiety and alcohol abuse). However, little is known about the ways in which they proceed. The aim of this study is to analyze GPs' management and patterns of referral to other health professionals of patients with work-related CMD and associated factors. METHOD: We used data from a cross-sectional study of 2027 working patients of 121 GPs in the Nord - Pas-de-Calais region in France (April - August 2014). Statistical analyses focused on patients with work-related CMD detected by the GP and examined the ways in which GPs managed these patients' symptoms. Associations between patient, work, GP and contextual characteristics and GPs' management were explored using modified Poisson regression models with robust variance. RESULTS: Among the 533 patients with work-related CMD in the study, GPs provided psychosocial support to 88.0%, prescribed psychotropic treatment to 82.4% and put 50.7% on sick leave. Referral rates to mental health specialists and occupational physicians were respectively 39.8 and 26.1%. Several factors including patients' characteristics (occupational and sociodemographic), GPs' characteristics and environmental data were associated with the type of management used by the GP. CONCLUSION: Our study emphasizes the major and often lonesome role of the GP in the management of patients with work-related CMDs. Better knowledge of the way GPs manage those patients could help GPs in their practice, improve patients care and be a starting point to implement a more collaborative care approach.
Asunto(s)
Alcoholismo , Ansiedad , Trastorno Depresivo , Medicina General , Estrés Laboral , Intervención Psicosocial , Psicotrópicos/uso terapéutico , Adulto , Alcoholismo/epidemiología , Alcoholismo/etiología , Alcoholismo/psicología , Alcoholismo/terapia , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/terapia , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Trastorno Depresivo/terapia , Femenino , Francia/epidemiología , Medicina General/métodos , Medicina General/estadística & datos numéricos , Humanos , Masculino , Salud Mental , Estrés Laboral/complicaciones , Estrés Laboral/psicología , Pautas de la Práctica en Medicina , Intervención Psicosocial/métodos , Intervención Psicosocial/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Factores de Riesgo , Ausencia por Enfermedad/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
General practitioners (GP), on the frontline for individuals with mental health problems, often deal with work-related common psychiatric disorders. We aimed to determine the prevalence of work-related common psychiatric disorders in general practice and associated patients' and GPs' characteristics. HERACLES, a cross-sectional study among 2019 working patients of 121 GPs in the Nord - Pas-de-Calais region in France. Common psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview, patient-perceived psychological distress and GP-diagnosed psychiatric disorders. The work-relatedness of common psychiatric disorders was ascertained by the GP and/or the patient. Prevalence rates adjusted on age were calculated by sex and associated characteristics were ascertained using multilevel Poisson regression models. The prevalence of work-related common psychiatric disorders ascertained using the MINI was estimated at 25.6% [23.7-27.5], 24.5% [22.6-26.4] for self-reported psychological distress and 25.8% [23.9-27.7] for GP-diagnosed psychiatric disorders. Age, history of psychiatric disorders, consultation for psychological purpose and GP's characteristics were associated with MINI-identified psychiatric disorders. The prevalence of work-related common psychiatric disorders among working adults seen in general practice is high but further studies are needed to support this results.