Patients Wary of Discussing Depression with Primary Care Physicians

A survey of 1,054 California adults found that almost half saw at least one significant obstacle to discussing symptoms of depression with their primary care physician. The results of the survey, which appear in the September/October issue of Annals of Family Medicine, were based on follow-up telephone interviews with participants in the 2008 California Behavioral Risk Factor Survey System about their beliefs regarding depression and potential reasons for not disclosing symptoms of depression to a PCP.
 
When presented with 11 possible barriers to disclosing symptoms of depression, 43% of respondents reported that at least one applied to them a lot. The three most commonly cited barriers were the concern that the PCP would prescribe antidepressant medication (23%); the belief that it is not the PCP’s job to deal with emotional issues (16%); and concerns about the confidentiality of medical records (15%). Other barriers identified by at least 10% of respondents included fear of referral to a counselor or psychiatrist and the potential stigma of being labeled a psychiatric patient.
 
Respondents with no history of depression were more likely to worry about being prescribed medication for depression and being referred to a psychiatrist, while those with a history of depression were more worried about medical record confidentiality and losing emotional control.
 
Women, Hispanics, and those with less education or lower income saw more barriers to disclosing symptoms of depression, as did those who felt depression was stigmatizing or should be within one’s control, those with more severe symptoms of depression, and those without a family history of depression. Those who had a friend or family member who had dealt with depression, on the other hand, tended to see fewer obstacles to disclosing symptoms.
 
“Ironically, those who most subscribed to potential reasons for not talking to a primary care physician about their depression tended to be those who had the greatest potential to benefit from such conversations—individuals with moderate to severe depressive symptoms,” the researchers wrote.
 
Despite the widespread perception of barriers to discussing depression with PCPs, seven of eight respondents said that a PCP is an appropriate source of depression care, and just 6% doubted their ability to talk about depression with their doctor. The researchers note that further investigation is necessary to determine whether respondents overestimated their ability to have such a conversation.
 
Source
Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care [Annals of Family Medicine]