Obstetrician-gynecologists’ knowledge, attitudes and practices regarding major depressive disorder

Abstract

Background: Obstetrician-gynecologists (ob-gyns) provide depression screening and treatment, but these practices could be improved. This study investigated the use of depression screening tools and treatment of adolescents with depressive symptoms.

Methods: Surveys were sent to 220 members of the American College of Obstetricians and Gynecologists (ACOG) who had responded to a survey on depression in the past two years. Response rate was 66% (n = 145). Questions included those related to standardized depression screening, antidepressant prescribing behavior, use of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) and knowledge of adolescent depression.

Results: A total of 40% use standardized screening tools for depression with 46% using the Beck Depression Inventory-II and only 5% using the Patient Health Questionnaire-2 (PHQ-2). The majority (89%) of ob-gyns do not employ the DSM-IV to confirm a diagnosis of major depressive disorder. Of the ob-gyns indicating treating depression with antidepressants, 97% prescribe selective serotonin reuptake inhibitors. Only 19 respondents do not prescribe antidepressants, and instead refer depressed patients to mental health specialists. Most (79%) ob-gyns identified sexual problems as the primary side effect deterring prescribing of antidepressant medication. Ob-gyns were fairly accurate at estimating the prevalence of adolescent depression.

Conclusion: Ob-gyns are not utilizing the recommended validated resources such as the DSM-IV or PHQ-2 for diagnosis of depression or prior to prescribing antidepressants.

• Adolescent
• depressive disorder
• diagnosis
• DSM-IV
• DSM-IV-PC
• gynecologist
• mental health
• obstetrician

Current knowledge on the subject

• MDD is twice as common in adolescent and adult females than in their male counterparts.

• Many women seek psychological care from their ob-gyn for signs and symptoms of depression, though research has shown that ob-gyns’ depression care could be improved.

• Few ob-gyns believe their mental health training to be adequate and about half perceived a lack of knowledge of diagnostic criteria as a barrier to providing depression care.

What this study adds to current knowledge

• This study is the first to assess:

• ob-gyns’ beliefs of the effectiveness of antidepressants,

• what side effects deter ob-gyns’ prescribing behavior,

• use of standardized depression screening tools and the DSM-IV to confirm a diagnosis of MDD prior to prescribing medication,

• knowledge about MDD in adolescents.