The attitudes and beliefs of Pakistani medical practitioners about depression: a cross-sectional study in Lahore using the Revised Depression Attitude Questionnaire (R-DAQ)

Mark Haddad, Ahmed Waqas, Wahhaj Qayyum, Maryam Shams, Saad Malik, Mark Haddad, Ahmed Waqas, Wahhaj Qayyum, Maryam Shams, Saad Malik

Abstract

Background: Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals' attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan.

Methods: A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ). A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey.

Results: Six hundred and one (86 %) of the doctors approached consented to participate; almost all respondents (99 %) endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes), and 37 % (between 13 and 19 % for particular causes) noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression.

Conclusions: Non-psychiatrist medical practitioners in Pakistan hold a range of views about the causes of depression, with supernatural explanations held by more than a third. Depression attitudes appear less positive than among UK and European clinicians, with the notions that depression is due to a lack of stamina and will-power and a natural part of growing old being especially commonly held; more positive attitudes appear to be associated with a rejection of supernatural explanatory models of depression.

References

    1. Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T. The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS One. 2015;10(2):e0116820. doi: 10.1371/journal.pone.0116820.
    1. Vos T. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. doi: 10.1016/S0140-6736(15)60692-4.
    1. Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry. 2014;1(6):467–482. doi: 10.1016/S2215-0366(14)00023-6.
    1. Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010;71(12):2150–2161. doi: 10.1016/j.socscimed.2010.09.030.
    1. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rusch N, Brown JS, Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27. doi: 10.1017/S0033291714000129.
    1. Schulze B. Stigma and mental health professionals: a review of the evidence on an intricate relationship. Int Rev Psychiatry. 2007;19(2):137–155. doi: 10.1080/09540260701278929.
    1. Lauber C, Rossler W. Stigma towards people with mental illness in developing countries in Asia. Int Rev Psychiatry. 2007;19(2):157–178. doi: 10.1080/09540260701278903.
    1. McCabe R, Priebe S. Explanatory models of illness in schizophrenia: comparison of four ethnic groups. Br J Psychiatry. 2004;185:25–30. doi: 10.1192/bjp.185.1.25.
    1. Singh SP, Brown L, Winsper C, Gajwani R, Islam Z, Jasani R, Parsons H, Rabbie-Khan F, Birchwood M. Ethnicity and pathways to care during first episode psychosis: the role of cultural illness attributions. BMC Psychiatry. 2015;15(1):287. doi: 10.1186/s12888-015-0665-9.
    1. Angermeyer MC, Holzinger A, Carta MG, Schomerus G. Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. Br J Psychiatry. 2011;199(5):367–372. doi: 10.1192/bjp.bp.110.085563.
    1. Dietrich S, Mergl R, Freudenberg P, Althaus D, Hegerl U. Impact of a campaign on the public's attitudes towards depression. Health Educ. Res. 2010;25(1):135–150.
    1. Fabrega H., Jr Psychiatric stigma in non-Western societies. Compr Psychiatry. 1991;32(6):534–551. doi: 10.1016/0010-440X(91)90033-9.
    1. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1(1):16–20.
    1. Deva MP. Bringing changes to Asian mental health. Int Rev Psychiatry. 2008;20(5):484–487. doi: 10.1080/09540260802397610.
    1. Richards M, Hori H, Sartorius N, Kunugi H. Cross-cultural comparisons of attitudes toward schizophrenia amongst the general population and physicians: a series of web-based surveys in Japan and the United States. Psychiatry Res. 2014;215(2):300–307. doi: 10.1016/j.psychres.2013.12.012.
    1. Adewuya AO, Oguntade AA. Doctors’ attitude towards people with mental illness in Western Nigeria. Social Psychiatry & Psychiatric Epidemiology. 2007;42(11):931–936. doi: 10.1007/s00127-007-0246-4.
    1. Fernando SM, Deane FP, McLeod HJ. Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness. Soc Psychiatry Psychiatr Epidemiol. 2010;45(7):733–739. doi: 10.1007/s00127-009-0113-6.
    1. Mas A, Hatim A. Stigma in mental illness: attitudes of medical students towards mental illness. Med J Malaysia. 2002;57(4):433–444.
    1. Giasuddin NA, Levav I, Gal G. Mental health stigma and attitudes to psychiatry among Bangladeshi medical students. Int J Soc Psychiatry. 2015;61(2):137–147. doi: 10.1177/0020764014537237.
    1. Naeem F, Ayub M, Javed Z, Irfan M, Haral F, Kingdon D. Stigma and psychiatric illness. A survey of attitude of medical students and doctors in Lahore, Pakistan. J Ayub Med Coll Abbottabad. 2006;18(3):46–49.
    1. Stuber JP, Rocha A, Christian A, Link BG. Conceptions of mental illness: attitudes of mental health professionals and the general public. Psychiatr Serv. 2014;65(4):490–497. doi: 10.1176/appi.ps.201300136.
    1. Jorm AF, Korten AE, Jacomb PA, Christensen H, Henderson S. Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Australian & New Zealand Journal of Psychiatry. 1999;3377(1):77–83. doi: 10.1046/j.1440-1614.1999.00513.x.
    1. Hori H, Richards M, Kawamoto Y, Kunugi H. Attitudes toward schizophrenia in the general population, psychiatric staff, physicians, and psychiatrists: a web-based survey in Japan. Psychiatry Res. 2011;186(2-3):183–189. doi: 10.1016/j.psychres.2010.08.019.
    1. Ando S, Yamaguchi S, Aoki Y, Thornicroft G. Review of mental-health-related stigma in Japan. Psychiatry Clin Neurosci. 2013;67(7):471–482. doi: 10.1111/pcn.12086.
    1. United Nations Development Programme. Human Development Report; 2015. . Accessed 14 Oct 2016.
    1. WHO. Country Cooperation Strategy: Pakistan. WHO/CCO/13.01/Pakistan; 2013. . Accessed 14 Oct 2016.
    1. WHO. Report on the Mental Health Situation in Pakistan: A report of the assessment of the mental health system in Pakistan using the World Health Organization - Assessment Instrument for Mental Health Systems (WHO-AIMS). WHO Office Islamabad; 2009. . Accessed 14 Oct 2016.
    1. Waqas A, Zubair M, Ghulam H, Wajih Ullah M, Zubair Tariq M. Public stigma associated with mental illnesses in Pakistani university students: a cross sectional survey. PeerJ. 2014;2:e698. doi: 10.7717/peerj.698.
    1. Haddad M, Menchetti M, McKeown E, Tylee A, Mann A. The development and psychometric properties of a measure of clinicians’ attitudes to depression: the revised Depression Attitude Questionnaire (R-DAQ) BMC Psychiatry. 2015;15(1):7. doi: 10.1186/s12888-014-0381-x.
    1. Botega N, Mann A, Blizard R, Wilkinson G. General Practitioners and depression - First use of the Depression Attitude Questionnaire. Int J Methods Psychiatr Res. 1992;2:169–180.
    1. Haddad M, Menchetti M, Walters P, Norton J, Tylee A, Mann A. Clinicians’ attitudes to depression in Europe: a pooled analysis of depression attitude questionnaire findings. Fam Pract. 2012;29(2):121–130. doi: 10.1093/fampra/cmr070.
    1. IBM Corp . IBM SPSS Statistics 22 for Windows. Armonk, New York: IBM Corp; 2013.
    1. Lorenzo-Seva U, Ferrando PJ. FACTOR: a computer program to fit the exploratory factor analysis model. Behav Res Methods. 2006;38(1):88–91. doi: 10.3758/BF03192753.
    1. Haddad M, Waqas A, Sukhera AB, Tarar AZ. The psychometric characteristics of the Revised Depression Attitude Questionnaire (R-DAQ) in Pakistani medical practitioners: a cross-sectional study of doctors in Lahore. BMC Research Notes. In press
    1. O'Brien RM. A caution regarding rules of thumb for variance inflation factors. Quality & Quantity. 2007;41(5):673–690. doi: 10.1007/s11135-006-9018-6.
    1. Mislevy RJ, Bock RD. BILOG 3 Item analysis and test scoring with binary logistic models. Mooresville: Scientific Software; 1990.
    1. Coppens E, Van Audenhove C, Scheerder G, Arensman E, Coffey C, Costa S, Koburger N, Gottlebe K, Gusmao R, O’Connor R, Postuvan V, Sarchiapone M, Sisask M, Szekely A, van der Feltz-Cornelis C, Hegerl U. Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. J Affect Disord. 2013;150(2):320–329. doi: 10.1016/j.jad.2013.04.013.
    1. Hagmayer Y, Engelmann N. Causal beliefs about depression in different cultural groups-what do cognitive psychological theories of causal learning and reasoning predict? Front Psychol. 2014;5:1303. doi: 10.3389/fpsyg.2014.01303.
    1. McClelland A, Khanam S, Furnham A. Cultural and age differences in beliefs about depression: British Bangladeshis vs. British Whites. Ment Health Relig Cult. 2014;17(3):225–238. doi: 10.1080/13674676.2013.785710.
    1. Korszun A, Dinos S, Ahmed K, Bhui K. Medical student attitudes about mental illness: does medical-school education reduce stigma? Acad Psychiatry. 2012;36(3):197–204. doi: 10.1176/appi.ap.10110159.
    1. Chambers M, Guise V, Valimaki M, Botelho MA, Scott A, Staniuliene V, Zanotti R. Nurses’ attitudes to mental illness: a comparison of a sample of nurses from five European countries. Int J Nurs Stud. 2010;47(3):350–362. doi: 10.1016/j.ijnurstu.2009.08.008.
    1. Haddad M. Different attitudes towards mental health revealed in a survey of nurses across five European countries; more positive attitudes found in Portugal, in women and in those in senior roles. Evid Based Nurs. 2010;13:115–116. doi: 10.1136/ebn.13.4.115.
    1. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. Br J Psychiatry. 2000;177:4–7. doi: 10.1192/bjp.177.1.4.
    1. Ohtsuki T, Kodaka M, Sakai R, Ishikura F, Watanabe Y, Mann A, Haddad M, Yamada M, Inagaki M. Attitudes toward depression among Japanese non-psychiatric medical doctors: a cross-sectional study. BMC Res Notes. 2012;5:441. doi: 10.1186/1756-0500-5-441.
    1. Haddad M. Depression in adults with a chronic physical health problem: treatment and management. Int J Nurs Stud. 2009;46(11):1411–1414. doi: 10.1016/j.ijnurstu.2009.08.007.
    1. Ghio L, Gotelli S, Marcenaro M, Amore M, Natta W. Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. J Affect Disord. 2014;152–154:45–51. doi: 10.1016/j.jad.2013.10.002.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する