Abstract Minor and major forms of depression are the most common mental disorders seen in primary health care. The number of disability pensions granted for major depression multiplied in Finland during the years 1987 and 1995. Over half of the client visits in health care centres are conducted by nurses. In most cases, practice nurses, health visitors, midwifes and school nurses are the first contact the patient or client has in a primary health care. However, there is no published literature in Finland concerning the role of primary care nurses in the recognition and treatment of depression. The purpose of this study was to describe and analyse the notions of primary care nurses concerning the recognition and treatment of depression in primary health care. The first phase of the study was part of a primary health care depression project organized by the National Research and Development Center for Welfare and Health (STAKES). The data was collected with three questionnaires from the nurses in four health care centers (n = 281). The data were partly compared with the data from 58 doctors working in same health care centres. The intervention was a three-day training program on depression held in four health care centres. The first questionnair was filled by 68 % of the nurses, the second by 48% of the nurses and the third by 30% of the nurses. In the second phase of the study 13 nurses from five health care centres were interviewed. The interview material was analysed using a phenomenographic method. The most essential themes in the study were: Prevalence and recognition of depression in primary health care patients, symptoms of depression, abilities and resources of nurses and their co-workers in treating depressive patients, management of depression, multiprofessional co-operation and nurses personal experiences of depression. The nurses felt that depression is most common in the working aged population and the frequent attenders, but most difficult to recognize in children and elderly people. The most essential symptoms they mentioned were sleeping disturbances, thoughts of death, sadness,lack of pleasure and physical symptoms. In the nurses opinion, the most common reasons for depression were concrete or emotional losses and the female predisposition to depressiveness. They found it very difficult to arrange psychotherapy for their depressive patients and to get the patients families involved in the treatment. All of the interviewed nurses considered the doctors are too busy and drug-centred in their management of depression but yet doctors were the most important co-workers for nurses. After the training program the nurses opinions of the possibilities to treat depressive patients in health centres were more positive than before the training-program. On the basis of the notions of the interviewed nurses five different treatment orientations emerged. The treatment orientations reflect different attitudes in the willingness to treat depressive patients and to ask direct questions with psychological content, in assessing one's own ability to treat depressive patients and in assessing one's own tendency to get depressed. All of the interviewed nurses felt it their duty to help depressive patients, but most of them mentioned a lack of time, a lack of confidence in one's own abilities and a fear of responsibility as restraints to do more in helping depressive people. Nursing education should give more practical and theoretical knowledge and encouragement in the recognition and treatment of mental disorders, especially mild mood disorders. The multiprofessional co-operation and intervention models in in the treatment of depressive disorders at the primary health care level should be improved and the possibilities to preventive work increased. Preventive interventions should also include the recognition of nurses exhaustion before it develops into depression.

According to the American Psychological Association (2006), three components should be equally considered in treatment decision-making: empirical research, clinical judgment, and the client’s values and preference. Swift, Callahan, and Vollmer (2011) defined client preferences as specific attributes that are desired in a therapeutic setting and are divided into three categories: role, therapist, and treatment-type. Currently, there is no treatment orientation scale that measures treatment type and magnitude of the relationship. For this initial phase of development, 5 treatment orientations are being used as the basis of the Client Treatment Orientation Scale (CTOS): psychodynamic, existential, cognitive-behavioral therapy, acceptance and commitment therapy, and multicultural. The purpose of this study is to begin development of a treatment orientation scale with 5-7 questions per subscale domain. A total sample of 651 participants completed the survey, was English speaking, and aged 18 or over, with the majority being male (n = 334, 51.3%). The mean age of participants was 31.91 (SD = 8.23), with an equal distribution of degree type (e.g. psychiatrist, clinical psychology, counseling psychology, and school psychology) with psychiatry the most endorsed at 26.6% (n = 173). Overall, results did not support the use of the CTOS in applied or research settings. Reliability analyses for the 5 subscales were: psychodynamic (α = .52), existential (α = .32), cognitive-behavioral therapy (α = .64), acceptance and commitment therapy (α = .46), and multicultural (α = .63). There were various limitations of the study, such as being self-report and the possibility of not being representative of the particular orientations being measured. Future research could re-examine items for latent variables or refine the current items for another factor analysis study.