Blog | Wednesday, September 14, 2011

QD: News Every Day--Patients need prompting to bring up depression

More than two in five patients hesitate to discuss depression in the primary care setting, leading researchers to offer practical tips on how to encourage people to broach the subject.

The big reasons for not talking to doctors included fears about patient confidentiality and fear of losing emotional control in front of the doctor, among those with a history of depression. Among those with no prior history, a fear of antidepressants/psychiatry and the perception that primary care isn't the right setting are two big reasons.

To learn why patients choose not to talk about their depression, researchers conducted a follow-up telephone survey of 1,054 adults who had participated in the California Behavioral Risk Factor Survey System. Results appeared Sept. 13 at the Annals of Family Medicine.

Of the respondents, 43% reported one or more reasons for nondisclosure (17% one reason, 26% two or more reasons). Patient's were most worried that the physician would recommend antidepressants (22.9%; 95% confidence interval, 18.8% to 27.5%).

As with other studies, Hispanics offered more reasons for not talking with their doctor, the authors noted. The literature shows this demographic is less likely to use mental health services, and may opt for informal sources of care and support. The American College of Physicians offers support materials for the Latino community online.

The researchers wrote: "There is good news in these findings--7 of 8 respondents believed that the primary care physician is an appropriate source of depression care. Furthermore, few respondents reported that they would decline to talk with their doctor about depression because of embarrassment, privacy concerns, or loss of face. Surprisingly, only about 6% of respondents doubted their ability to initiate a conversation about depression with their doctor."

One of the study's authors, Richard L. Kravitz, MD, an ACP Fellow, told CNN, "The primary care sector cares for a majority of patients with mental health conditions in America, and we know that depression is undertreated everywhere. The number one reason for that is because recognition of depression starts with disclosure from the patient."

Practical solutions involve actively promoting mental health services in the primary care offices, Dr. Kravitz said. Tips include promoting it with pamphlets, posters, or questionnaires to show patients that depression lies within the scope of the practice.

More simple tools and the most recent guidelines were covered in recent issues of ACP Internist.