General practitioners' choices when starting treatment for major depression: Update of Dusmenil et al. survey (2012) in view of new mental health devices.

INTRODUCTION AND OBJECTIVES A 2011 study on general practitioners' (GP) management of major depressive disorders (MDD) revealed limited treatment options, predominantly pharmacotherapy. Since then, France has implemented mental health initiatives, including "Mon Soutien Psy", covering up to 12 psychologist sessions by health insurance (8 during our study). The program "Dispositif de Soins Partagés en Psychiatrie" (DSPP) is a specific scheme implemented in the Occitanie region (South of France) with the aim of improving collaboration between psychiatrists and GPs at a local level. The aim of this study was to investigate MDD care management in primary care according to the implementation of these new schemes.

METHODS We reused the 2011 case vignette survey, adding items related to new schemes. The survey was done by means of electronic-questionnaires sent to GPs by the regional Union of Health professionals in three different French administrative areas (Bouches-du-Rhône and Ille-et-Vilaine, with "Mon Soutien Psy", and Haute-Garonne for the DSPP).

RESULTS In total, 158 GPs completed the survey - 69.0% from Haute-Garonne - for a total response rate of 3.4%. Compared with the 2011 survey, there was a significant increase in the number of GPs managing patients in collaboration with a specialist (6.3 versus 3.3%; P<0.05) and assessing the situation before prescribing an antidepressant (44.2 versus 10.7%; P<0.00001). GPs were mostly from Haute-Garonne (DSPP area). Attitudes towards psychotherapies had improved since 2011, though some misconceptions persisted. Barriers were no longer the reimbursement or the patient's reluctance to undergo psychotherapy but rather the overly long wait to get an appointment. Overall, MDD management in primary care aligned more closely with the guidelines.

CONCLUSION Results indicate positive trends: GPs show greater adherence to MDD management guidelines and a willingness to consult specialists while handling cases independently. Nonetheless, further improvements are necessary with larger studies needed for validation. Recent mental health programs likely contributed to these advancements.