Table 2.
Studies of General Practitioner and Non-Psychiatric Physicians Education
| Source | Prevention Strategy | Length of intervention | Population | Study Type | Location | Outcome |
|---|---|---|---|---|---|---|
| Oyama, 2005(15) | Educational intervention for nurse depression screening and GP management | 8-yrs, screening and depression management | Older adults | Quasi-experimental* | Japan | Greater female suicide reduction in intervention region compared with control region (IRR =.35). No regional difference in male suicides. |
| Oyama, Fujita et. al, 2006(17) | Educational intervention for nurse depression screening and GP management | 10-yrs, screening and depression management | Older adults | Quasi-experimental* | Japan | Greater reduction in intervention region female suicide at a trend level compared with control region (IRR =.23). No regional difference in male suicides. |
| Oyama, Goto et. al, 2006(16) | Educational intervention for nurse depression screening and GP management | 10-yrs, screening and Depression management | Older adults | Quasi-experimental* | Japan | Greater reduction in female suicide rates in intervention region compared with control region (IRR =.43). No regional differences in male suicides. |
| Oyama, Ono et. al, 2006(14) | Educational intervention for nurse depression screening and GP management | 5-yrs, screening and Depression management | Older adults | Quasi-experimental* | Japan | Trend level reduction in female suicide rate in the intervention region (IRR=.26) but not in the control region. No change in male suicide rate. |
| Henriksson & Isacsson, 2006(18) | Yearly 2-day GP training sessions | 8-yrs, GP screening and depression treatment | Adults | Quasi-experimental* | Sweden | Pre-intervention (1970–1994), suicide rate was higher in Jamtland county than Sweden (p<.05), but during intervention period (19952002) it dropped in intervention region, so the two rates no longer differed. |
| Szanto et al., 2007(12) | Annual educational program for GPs and their nurses | 5-yrs, GP supervised depression management | Adults | Quasi-experimental* | Hungary | Decrease in suicide rate in intervention region greater than the larger county (p<.001) and Hungary (p<.001). |
| Alexopoulo s et al., 2009(22) | 2-yrs of GP training and case managers | 2-yrs with algorithm-based tx advice | Older adults | RCT## | United States | Intervention group more likely than to receive antidepressants or psychotherapy (p<.001), and those with major depression had lower rates of SI at 4, 8, and 24 months (p=.04). No difference in SB. |
| Hegerl et al., 2010(21) | 2-Yr, four-level intervention program including GP education | 2-yrs, GP depression management | Adults | Quasi-Experimental* | Germany | Intervention region had greater reduction in suicidal acts (suicides + SA) (p<.0065) and SA (p<.0005) versus control from baseline to 1-year follow-up of the 2-year intervention (2000–2003). The reduction in SA was more pronounced for high-lethality than low-lethality methods and persisted for four years. |
| Hübner-Liebermann et al., 2010(19) | 5-yrs of four-level intervention program including GP education in depression management | 5-yrs, GP depression management | Adults | Quasi-experimental* | Germany | The suicide rate declined in the intervention region (p=.02) but not in the control region. |
| Roškar et al., 2010(27) | One-day GP educational program | 3-yrs of GP depression management | Adults | Quasi-Experimental** | Slovenia | Intervention group had greater increase in antidepressant prescriptions (p<.05) compared with controls but no group differences in suicide rate. |
| Almeida et al., 2012(26) | 2-yrs, GP practice audit with feedback on depression and self-harm, educational materials and control education GP group. | 2-yrs of GP depression management | Older adults | RCT# | Australia | Intervention group had less self-harm behaviors (0R=.80, p<.05) over 2-yrs. |
| Hegerl et al., 2019(20) | 2-yrs, four-level intervention program including GP training, GP consultation hotline | 2-yrs of GP depression treatment | Adults | Quasi-experimental* | Germany, Hungary, Ireland & Portugal | In Portugal, the intervention region saw a greater reduction in suicidal acts (suicides + SA) (p=.05) and SA (p=.02) compared with control region. No group differences found in 3 other countries. |
Studies used a control region as a comparison and examined time periods before and after intervention onset. For such community level intervention studies there were no inclusion or exclusion criteria employed.
Study used physicians who did not attend GP training as control group for two regions and had one region as additional control, pre-post intervention time periods were examined.
OR=Odds Ratio; IRR= incidence rate ratio; tx = treatment
General Practitioner Inclusion Criteria: on a list provided by Australasian Medical Publishing Company, worked at least 2 days per week, had at least 50 patients aged 60+ who spoke English, and were not planning to retire or move practice within the next two years. Sample size: GP N=373 (with N=21,762 patients aged 60+), intervention GP N=188 (N= 11,402 patients aged 60+), control GP N=185 (N= 10,360 patients aged 60+).
Patient Inclusion Criteria: treated at one of the 20 primary care practices participating in the study, aged 60+, met DSM-IV criteria for major or minor depression, defined as 3–4 depressive symptoms, score on the 24-item Hamilton Depression Rating Scale (HAM-D) ≥10, and a duration of at least 1 month. Sample size: Patients N=599, intervention N=320, control N=279.