Tension between evidence-based medicine and perceived need for care for anxiety and depression

Patients with a depressive or anxiety disorder prefer talking about their problems over medication, but they receive medication more often. This was concluded in a NIVEL study, on which Marijn Prins defended her thesis at Utrecht University.
 

Anxiety and depression are common mental disorders. Nearly half (43%) of those with an anxiety or depressive disorder do not seek any help. Of the persons who do seek help, 42% receives care from their general practitioner and 14% receives specialised care. Today, evidence-based medicine and patient-centred medicine are the two leading paradigms in general and mental health care. In the past decades, the focus on health care has shifted from a paternalistic, doctor’s perspective to a more demand-driven, patient’s perspective.

Guidelines
Of 721 patients with a current anxiety or depressive disorder who were recruited from general practices, 39% received guideline-concordant care. “It should be mentioned that more than half of the patients who did not receive care according to the guidelines, have not sought any care or did not want help”, says Marijn Prins. “Patients with more severe symptoms and comorbidity of both anxiety and depression were more likely to receive care according to the guidelines, just as patients with a perceived need for care and a high education level.” 

Psychological treatment
Although general practice guidelines for anxiety and depression recommend both medication and psychological treatment, general practitioners seem to prescribe medication more often. “Here you can see a certain amount of conflict”, says Prins. “Patients with anxiety or depression seem to prefer psychological treatment over medication. Their perceived need for information, counselling or psychotherapy is often unmet. Although counselling and education are part of guidelines as well.”