Pharmacists Back Depression Care in Theory but Fall Short in Practice, Saudi Survey Finds

Community pharmacists in Saudi Arabia are among the most accessible healthcare professionals in the country, yet a new cross-sectional study suggests they are falling short of their potential as frontline supporters of people living with depression. The research, published in BMC Health Services Research by a team led by Fahad Alzahrani of Taibah University, surveyed 377 licensed community pharmacists and found a striking disconnect between what pharmacists believe about their role in depression care and what they actually do behind the counter. While attitudes toward mental health support were moderately positive, the measured level of depression-care practice reached only about half of its potential score, a gap the authors attribute largely to structural barriers rather than reluctance or stigma alone.

The study, conducted between October 2024 and January 2025, invited 533 community pharmacists from across Saudi Arabia to complete a validated questionnaire assessing three domains: their current practices in depression care, their perceptions and attitudes, and the barriers they face. With a participation rate of 70.7 percent, the survey offers one of the more comprehensive snapshots to date of how community pharmacists in the Kingdom engage with mental health presentations. Respondents were scored on the frequency with which they performed specific depression-related activities, from screening and counseling to referral, and the researchers then used multiple linear regression to identify which pharmacist characteristics predicted stronger or weaker practice.

The headline numbers tell a story of misaligned capacity. The overall practice score came in at 51.0 percent, which the authors characterize as low, while the perception and attitude score reached 77.4 percent, indicating a moderate level of positive orientation toward depression care. In other words, pharmacists largely accept that they have a legitimate role in supporting patients with depression, whether through medication management, adherence counseling, or referral to physicians, but that acceptance rarely translates into consistent action. This attitude-practice gap is a well-recognized phenomenon in health services research, and the Saudi data add a detailed national case study of how professional beliefs can outrun institutional support.

Not all depression-related activities were equally neglected. The most commonly reported practices were encouraging patients to adhere to their antidepressant medications and checking prescription details before dispensing. These are tasks that fit naturally into the existing workflow of a community pharmacy and require little additional infrastructure. By contrast, less frequent activities included consulting with physicians about patient care and providing written educational materials about depression. The pattern is telling: pharmacists are comfortable performing the mechanical elements of pharmaceutical care, but the communicative and collaborative components, those that require time, privacy, and established referral relationships, lag behind. It is precisely these latter activities that international guidelines on collaborative mental health care tend to emphasize.

The barriers pharmacists reported form a coherent picture of a system not yet designed for mental health work at the community level. The most significant obstacles included limited access to patient medical profiles, which prevents pharmacists from seeing the full clinical picture behind a prescription; poor patient understanding of depression, which complicates counseling; a lack of privacy in pharmacies, where counseling about a psychiatric condition can be overheard by other customers; time constraints in busy dispensing environments; and inadequate mental health training. Each of these barriers maps onto a specific fix: integrated health records, public education, redesigned pharmacy spaces, realistic workload expectations, and targeted professional development. The authors argue that addressing these structural issues, rather than simply exhorting pharmacists to do more, is the key to unlocking the profession’s contribution.

The regression analysis added statistical texture to these findings. The overall model was significant, explaining roughly 22 percent of the variance in practice scores, and several demographic and workload factors emerged as meaningful predictors. Greater professional experience was associated with higher practice scores, suggesting that depression care skills accumulate over a career, perhaps through repeated patient encounters and informal learning. Interestingly, pharmacists aged 30 to 39 years scored lower than those aged 20 to 29, a counterintuitive result that may reflect the compounded pressures of mid-career workloads and family responsibilities, though the study design cannot establish causation. Dispensing between 50 and 100 prescriptions daily was associated with higher practice scores, possibly because this moderate workload level provides enough patient contact to practice depression-related activities without the paralyzing time pressure of very high volumes.

One of the most consequential negative findings concerned training. Depression-specific training was not significantly associated with higher practice scores in the regression model, with the coefficient falling just short of conventional statistical significance. This result deserves careful interpretation. It may indicate that existing training programs are not sufficiently practical or competency-based to change behavior, that trained pharmacists still face the same structural barriers that nullify their additional skills, or that the self-reported nature of training exposure obscures real differences in training quality. The authors conclude that competency-based training, explicitly designed to overcome the barriers pharmacists face, is needed rather than generic mental health education alone.

The significance of this research extends beyond Saudi Arabia. Depression is a major and growing public health burden worldwide, and health systems everywhere struggle to provide timely access to mental health services. Community pharmacists occupy a unique position in the response: they are geographically distributed, do not require appointments, are visited repeatedly by patients with chronic conditions, and are often the healthcare professional a person sees most frequently. International health policy frameworks have increasingly called for pharmacists to take on expanded roles in mental health, including medication reconciliation, adherence support, recognition of worsening symptoms, and structured referral. The Saudi study provides a template for measuring how far real-world pharmacy practice sits from that aspiration, and its methods could be replicated in other countries facing similar gaps.

What would it take to close the gap the study documents? The authors outline a reform agenda built on five pillars: competency-based training programs that emphasize practical skills over theoretical knowledge; better access to patient medical profiles through integrated digital health records, aligning with Saudi Arabia’s broader health digitization agenda under Vision 2030; private counseling spaces within or adjacent to pharmacies; clearly defined referral pathways that connect pharmacists to primary care physicians and mental health specialists; and stronger interprofessional collaboration, so that a pharmacist’s concern about a patient reaches a physician quickly and reliably. None of these interventions is technologically exotic, and several are already underway in other health systems that have formalized pharmacist roles in collaborative care models for depression.

The study also carries a message for patients and the public. Poor patient understanding of depression ranked among the top barriers reported by pharmacists, which means the problem is bidirectional: pharmacists cannot counsel effectively if patients do not recognize depression as a treatable medical condition or feel able to discuss it. Reducing mental health stigma and improving mental health literacy in the general population would directly amplify the effectiveness of any pharmacy-based intervention. As health systems worldwide search for scalable ways to ease the burden of depression, this Saudi survey offers a sober but hopeful conclusion: the workforce is willing, the attitudes are broadly supportive, and what stands between intention and impact is a set of fixable structural problems, from missing medical records to missing private corners in which a difficult conversation can finally take place.

Subject of Research: Community pharmacists' role and barriers in depression care in Saudi Arabia

Article Title: Community pharmacists’ practices, perceptions, and barriers in depression care: a cross-sectional study in Saudi Arabia

Article References: Alzahrani, F., Aljohani, M., Alhusini, L. M., Alluhibi, H., Aljohani, L. S., Al Thaqfan, S. S., Fallatah, S. B., Alzahrani, S., & Alnezary, F. S. (2026). Community pharmacists’ practices, perceptions, and barriers in depression care: a cross-sectional study in Saudi Arabia. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15551-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15551-6

Keywords: depression, community pharmacists, Saudi Arabia, mental health, pharmacy practice, cross-sectional study, barriers, antidepressant adherence, referral pathways, interprofessional collaboration, health services research, pharmacist training