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Variation in professional practice is a complex issue, but probably largely reflects differences in training, and there is evidence that guidelines and education alone have little impact on professional behaviour.
The increasing recognition of depressive illness as a major public health problem1 has intensified research efforts and also highlighted the extent of variation in professional practice. Because depressive illness is so prevalent, most cases are not managed by specialists. Although healthcare systems differ, general medical practitioners are the professional group most often involved. The training in mental health provided for such doctors is variable, but usually does not mirror the high prevalence of the common conditions—for example, in the UK less than half of general practitioners may receive specialist training experience in mental health. There is similar variation in the training of other professional groups. It is therefore no surprise that there is variation in professional practice both within and between such groups, as shown by Tiemeier et al2 in their vignette study published in …