A Qualitative Study of Depression in Primary Care

Missed Opportunities for Diagnosis and Education

Saver, Barry G. MD, MPH
Van-Nguyen, Victoria BA
Keppel, Gina BA
Doescher, Mark P. MD, MSPH

Department of Family Medicine (BGS, VV-N, GK, MPD), University of Washington, Seattle, WA; School of Education (VV-N), University of Washington, Seattle, WA; School of Public Health (GK), University of Washington, Seattle, WA

Corresponding author: Barry G. Saver, MD, MPH, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Benedict Building A3-146, Worcester, MA 01655 (E-mail: [email protected])

Prior presentation: A portion of this work was presented at the 33rd North American Primary Care Research Group Annual Meeting, Quebec City, Quebec, October 15–18, 2005.

Conflict of interest: none reported.

Submitted 8 February 2006; revised 27 September 2006; accepted 5 October 2006.

This article was externally peer-reviewed.

Journal of the American Board of Family Medicine 20(1):p 28-35, January-February 2007.

Purpose

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.

Methods

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.

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.

Conclusions

In this sample of depressed patients, we found evidence of frequent missed diagnoses, substantial information gaps, and limited patient understanding and choice of treatment options. Quality improvement efforts should address not only screening and follow-up but patient education about depression and treatment options along with elicitation of treatment preferences.