Depression is one of Chile's main public health problems due to its prevalence and associated disability, annually affecting 6.2% of the adult population. Patients with mild, moderate and severe depression should be attended in PHC, by mandate of the Ministry of Health. However, PHC psychologists must face complex patients where depression is associated with personality dysfunctions (e.g. comorbidity with personality disorders), having few competences in this regard.
This paper presents a training program-protocol in psychotherapeutic competencies (TPPC) for the management of depression and complex depression for PHC psychologists. The construction of the program combined information obtained from in-depth interviews with patients, PHC psychologists and experts. Patients expected to not only deal with their depressive symptoms, but with personality structure functioning like emotional dysregulation, impulsivity and intense anxiety. The program was also based in general research evidence and evidence obtained from the research program of the Millennium Institute for Research in Depression and Personality (MIDAP). The management of personality dysfunction was based on Good Psychiatric Management (GPM), DBT strategies, but specially on the Operationalized Psychodynamic Diagnosis (OPD) system. The OPD focuses, from a dimensional perspective, on personality structure capacities that are compromised in these patients, for a specific indication and treatment.
The content of the TPPC was subjected to a Delphi validation by 7 experts and the acceptability of the program was finally measured in a pilot application in 14 PHC psychologists. The Sekhon (2017) acceptability constructs based on the seven components of affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy, showed a positive perception of the program. The workload with patients, the administrative difficulties of conducting psychotherapy in a PHC context, and the fact that psychologists sometimes had to use their free time to participate in the TPPC affected the acceptability of the program.
This program’s contribution to Chile’s mental health challenges is discussed.