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Exploring the macro level barriers that affect Iranian GPs’ diagnosis and management of depression disorders

Mandana Shirazi, Roghayeh Gandomkar, Sari Ponzer, Charlotte Silen


Background: The fact that general practitioners (GPs) find it difficult to detect and treat depression is a worldwide concern. This is also the case in Iran, where this study was conducted. Educational interventions have been used to support GPs in their work when treating patients with depression disorders.

Objective: To explore GPs' views regarding macro level barriers of the management of depression in primary care settings.

Methods: In this qualitative study, semi-structured interviews exploring GPs’ views, beliefs and experiences regarding the diagnosis and treatment of depression were done. A purposeful sampling to obtain a broad range of views was carried out among GPs that had previously participated in an educational intervention study. Eleven GPs were interviewed and their views were probed in depth to get rich descriptions to ensure trustworthiness of the data. The data were analyzed by using qualitative content  analysis.

Results: GPs’ beliefs regarding macro level barriers emerged as 2 significant themes Organizational and Society-Related factors. The Organizational factors included barriers related to the local health network system and organizational support and the Society-Related factors included economic, cultural and social factors. The individual GP´s opinions about management strategies seemed not to be related to their perceptions of macro level barriers.

Conclusion: The results of this study imply that a number of macro level obstacles were of great importance when managing patients with depression disorders. In order to improve the effectiveness of CME events they should be tailored for the actual context and the infrastructural issues that is, organizational and societal factors should be addressed.


Depression, GP diagnosis, Iranian context, macro level barriers, person-centered medicine, person-centered psychiatry

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