for the Nottingham Counselling and Antidepressants
in Primary Care (CAPC) Study Group.
We performed a cross-sectional survey of general practice
attenders to determine their preferences regarding treat-
ment for depression and characteristics associated with
such preferences. Counselling was more popular than drug
therapy (antidepressants), particularly among women, those
who believed antidepressants are addictive, and those who
had received such treatment in the past.
Keywords: patient attitudes; depression; antidepressants.
depressant medication but such treatment is relatively
unpopular with the general public who favour psychological
approaches.1-5Patient attitudes to treatment have implications for
compliance and satisfaction but little is known about the factors
that influence such preference. We therefore performed a study
to investigate this among a population of general practice atten-
ders, since these are subjects to whom the findings would be of
greatest relevance. We examined associations with age, sex, the
presence of current depressive symptoms, previous experience of
treated depression, and attitudes to depression.
AJOR depression can often be treated effectively with anti-
We performed a self-completion questionnaire survey among
adult patients attending 20 general practices in the Trent Region.
Practices were participating in a trial of treatments for depression
but the survey was independent of that study. A researcher dis-
tributed the questionnaire to consecutive patients at randomly
selected surgery sessions, with a target sample size of 0.5% of
the adult list size.
The questionnaire consisted of five sections, each containing
closed questions requiring mainly single tick box or categorical
1. Age and sex.
2. True/false responses to knowledge/attitudinal statements
about aspects of depression.
3. Previous experience of treated depression in themselves or
4. Ranking four treatment options (trying to pull themselves
together; seeing a psychiatrist; taking tablets; and seeing a
counsellor/therapist) by preference should they ever require
treatment for depression.
5. Current depressive symptomatology as assessed by the Beck
Depression Inventory (BDI).3
Data analysis was performed using the Statistical Package for
Social Sciences (SPSS for Windows version 8.0). We examined
associations in relation to preferred (highest ranked) treatment
using chi-squared tests and logistic regression analysis to calcu-
late estimated odds ratios (with 95% confidence intervals) for
independently associated factors.
Nine hundred and eighty-four surgery attenders were asked to
complete questionnaires and 895 (91%) did so. Of those who
completed questionnaires, 32% were male (mean age = 40 years)
and 68% were female (mean age = 42 years). Two hundred and
sixty (29.1%) responders reported personal experience of being
treated for depression and, of these, 75.8% reported having been
prescribed medication, 28.5% had seen a counsellor or psycholo-
gist, and 8% had been referred to a psychiatrist. Two hundred
and eighty-two (32.1%) of the 878 patients who completed the
BDI had a score of 11 or more, consistent with the presence of
Most responders (98.9%) agreed with the statement that
‘depression can be a serious illness’ and the majority (94.3%)
acknowledged that it is a common disorder by agreeing that ‘one
in five people suffer from depression at some point during their
lives’. Approximately half (47.8%) agreed that depression is
always a reaction to external problems. Just over one-third
(35.7%) agreed with the statement that ‘if you are depressed you
have to pull yourself together’. Significantly more men (67.4%)
than women (54%) believed antidepressants to be ‘addictive’
(χ2 = 8.38, df = 1, P = 0.004).
In terms of treatment preference, approximately three times as
many patients favoured counselling (50.8%) as favoured drug
treatment (15.3%). Table 1 shows characteristics independently
associated with a preference for counselling after logistic regres-
sion analysis. There was a positive association with female sex,
previous experience of counselling, and a belief that antidepres-
sants are addictive. There was a negative association with
perceptions that ‘depression is always caused by problems in
people’s lives’ or that ‘if you have depression you have to pull
yourself together’. There were no associations between a prefer-
ence for counselling and age, overall experience of treated
depression or the presence of current depressive symptoms.
Treating depression in general practice: factors
affecting patients’ treatment preferences
R Churchill, MSc, MRCGP, lecturer in general practice; M Khaira BMedSci,
medical student; V Gretton, PhD, research assistant; C Chilvers DSc(Hon),
MFPHM, professor of epidemiology and director of Trent Institute for
Health Services Research; M Dewey, PhD, senior lecturer in health services
research; and A Lee, MA, FRCPsych, consultant psychiatrist and special
senior lecturer, University of Nottingham Medical School. C Duggan, PhD,
MRCPsych, professor of forensic psychiatry, Leicester.
Submitted: 4 February 2000; Editor’s response: 9 May 2000; final accep-
tance: 9 August 2000.
© British Journal of General Practice, 2000, 50, 905-906.
British Journal of General Practice, November 2000905
This is the largest reported survey of attitudes to treatments for
depression among general practice surgery attenders. Our find-
ings confirm those of other studies among the general public that
counselling is a preferred mode of treatment for depression.1-5
Such preference is partly related to negative beliefs about the
addictiveness of antidepressants. Evidence about the effective-
ness of counselling for depression is lacking,6while antidepres-
sants are of known benefit. However, the Defeat Depression
Campaign had limited impact on changing negative public
beliefs about antidepressants.1The results of studies evaluating
the effectiveness of counselling for depression in primary care
are needed to decide whether or not we should be trying to
persuade the public that counselling is not as worthwhile as they
think it is.
1. Paykel ES, Hart D, Priest RG. Changes in public attitudes to depres-
sion during the Defeat Depression Campaign. Br J Psychiatry 1998;
2. Zeitlin D, Katona C, D’Ath P, Katona P. Attitudes to depression in
primary care attenders: Effects of age and depressive symptoms.
Prim Care Psychiatry 1997; 3(1): 17-20.
3. Angermeyer MC, Matschinger H. Public attitude towards psychiatric
treatment. Acta Psychiatr Scand 1996; 94: 326-336.
4. Brody DS, Khaliq AA, Thompson IT. Patients’ perspectives on the
management of emotional distress in primary care settings. J Gen
Intern Med 1997; 12(7): 403-406.
5. Jorm AF, Korten AE, Rodgers B, et al. Belief systems of the general
public concerning the appropriate treatments for mental disorders.
Soc Psychiatry Psychiatr Epidemiol 1997; 32: 468-473.
6. Churchill RD, Dewey M, Gretton V, et al. Should general practition-
ers refer patients with major depression to counsellors? A review of
current published evidence. Br J Gen Pract 1999; 49: 737-743.
We are grateful to the practices and patients who participated in this study
and to NHSE Trent R&D who funded the CAPC study.
Address for correspondence
Dr Richard Churchill, Division of General Practice, Nottingham
University Medical School, Queen’s Medical Centre, Nottingham NG7
2UH. Email: firstname.lastname@example.org
906British Journal of General Practice, November 2000
R Churchill, M Khaira, V Gretton, et al
Table 1. Patient characteristics associated with preference for counselling (logistic regression analysis).
Variable Estimated OR95% CI
Experience of treated depression
Personal experience of treatment
Tablets or medication
Counselling or psychological treatment
Current depressive symptoms
Beck Depression Inventory score
Attitudes and beliefs
Depression can be a serious illness
Depression is always caused by problems in people’s lives
20% of people suffer from depression at some time
If you have depression you have to pull yourself together
Antidepressants are addictive