RESEARCH7

A Qualitative Study of Depression in Primary Care: Missed Opportunities for Diagnosis and Education

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•objectives

Objectives: Depression is one of the most commonly encountered chronic conditions in primary care, yet it remains substantially underdiagnosed and undertreated. We sought to gain a better understanding of barriers to diagnosis of and entering treatment for depression in primary care.

•methodology

We conducted and analyzed interviews with 15 subjects currently being treated for depression recruited from primary care clinics in an academic medical center and an academic public hospital. We asked about experiences with being diagnosed with depression and starting treatment, focusing on barriers to diagnosis, subject understanding of depression, and information issues related to treatment decisions.

In this study, we report results of qualitative analyses of interviews with patients currently under treatment for depression about their experiences with being diagnosed with and starting treatment for depression. We specifically sought to explore their understanding of depression before and after receiving the diagnosis, sources and adequacy of information about depression and its treatment options, and their roles in choosing treatment options. We chose a qualitative approach because of the limited extant information in this area to “map the terrain” and be open to unexpected findings.

•results

Subjects reported many visits to primary care practitioners without the question of depression being raised. The majority had recurrent depression. Many reported that they did not receive enough information about depression and its treatment options. In the majority of cases, practitioners decided the course of treatment with little input from the patients.

The 15 participants ranged in age from their mid-20s to their late 50s, with about half in their mid-40s, and were evenly split between males and females. There were 7 Caucasian, 6 African American, 1 Asian American, and 1 Native American subjects. Six participants reported college or graduate degrees, and 6 more reported some college education. Four subjects mentioned a diagnosis of bipolar disorder, 3 reported anxiety disorders, and 5 gave histories of substance use problems. We chose to retain and analyze interviews with participants reporting a diagnosis of bipolar disorder, because their reported experiences with depression diagnosis and treatment were quite similar to those of our participants not reporting a bipolar diagnosis, and depression is a common presentation of bipolar disorder. Similarly, we have retained the participants in our sample who reported histories of substance use as the issues raised by these participants were very much the same as those raised by other participants, with the addition of active substance use being a barrier to willingness to undertake treatment for depression.