Physician self-efficacy and primary care management of maternal depression

The negative impact of maternal depression on both the mother and her offspring highlight the importance of managing (diagnosing/treating) maternal depression in primary care. Despite this heightened emphasis, many primary care physicians still fail to diagnose and treat maternal depression. In order to address this apparent gap between opportunity for care and actual care delivery, the present surveillance study examined the relationships among physicians' beliefs, knowledge, self-efficacy, perceived barriers toward and practices related to managing maternal depression. Methods: A total of 232 physicians (i.e. obstetrics, pediatricians, and family medicine practitioners) residing in Southeastern Virginia completed a 60-item survey, either by web or mail. The 60-item survey contained questions pertaining to demographics, physicians' attitudes, beliefs, efficacy, current practices and perceived barriers regarding the management of maternal depression. Structural equation modeling was used to estimate a model that examined the relationships among physicians' knowledge, beliefs, self-efficacy, perceived barriers, past training toward and current management practices for maternal depression (i.e. frequency of assessment, referral, consultation, and treatment). Results: Two significant indirect pathways were observed. Lack of educational training negatively impacted management practices via self-efficacy (std. indirect effect = -.310, p < .0001). Perceived patient barriers also impacted management practices via self-efficacy (std. indirect = -.117, p = .02). Overall, this model predicted approximately 64% of the variance in management practices. Conclusions: These findings will guide the development of future multifaceted intervention strategies to enhance physician skills in managing maternal depression in primary care.

This study was funded by AHRQ grant #7 R03 HS015764-02