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

Saver, Barry G.; Van-Nguyen, Victoria; Keppel, Gina A.; Doescher, Mark P.

doi:10.3122/jabfm.2007.01.060026

Cited by 50 publications

(37 citation statements)

References 28 publications

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“…[51][52][53][54] Encouraging patients to discuss their Internet findings with their doctors would be a way of improving this situation; however, doctors often feel that the patient who brings information retrieved from the web to discuss is challenging their authority, and that they make the visit less time-efficient. 55 If consumers have difficulties appraising and discussing the information they find on the web with their doctors, they may end up making uncritical healthcare decisions based on non-evidence-based information.…”

Section: Discussionmentioning

confidence: 99%

Googling caesarean section: a survey on the quality of the information available on the Internet

Fioretti

Reiter

Betrán

et al. 2014

BJOG: Int J Obstet Gy

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Objective To examine the quality and completeness of information on caesarean section in web pages used by laypersons in Brazil, a country with very high rates of caesarean delivery.Design Cross-sectional study.Setting Brazil.Sample A total of 176 Internet websites.Methods The term 'caesarean delivery' and 25 synonyms were entered into the most popular search engines in Brazil. The first three pages of hits were downloaded and assessed by two independent investigators using the DISCERN instrument and a content checklist.Main outcome measures Quality and completeness of information on caesarean section.Results A total of 3900 web pages were retrieved and 176 fulfilled the selection criteria. The overall average DISCERN score was 43.6 (AE8.9 SD), of a maximum score of 75; 30% of the pages were of poor or very poor quality and 47% were of moderate quality. Most pages scored low, especially in questions related to reliability of the information. The most frequently covered topics were: indications for caesarean section (80% of websites), which did not reflect clinical practice; short-term maternal risks (80%); and potential benefits of caesarean section (56%), including maternal and doctor convenience. Less than half of the websites mentioned perinatal risks and less than one-third mentioned long-term maternal risks associated with caesarean section, such as uterine rupture (17%) or placenta praevia/accreta (12%) in future pregnancies.Conclusions The quality and completeness of web-based resources in Portuguese about caesarean section were poor to moderate. Pending improvement of these resources, obstetricians should warn pregnant women about these facts and encourage them to discuss what they have read on the Internet about caesarean section.Keywords Caesarean section, doctor-patient relationships, health literacy, Internet, patient education, prenatal education.Tweetable abstract The quality and completeness of information about caesareans is poor in 176 websites used by Brazilians.Keywords Caesarean section, doctor-patient relationships, health literacy, Internet, patient education, prenatal education. IntroductionIn 1985, the World Health Organization (WHO) stated that there were no justifications for caesarean section rates higher than 10-15% anywhere in the world, 1 and yet rates are steadily increasing worldwide.2 Brazil has been the world champion of delivery by caesarean section since the early 1990s, 3 and numbers continue to rise. In 2010 over 50% of all deliveries in Brazil were by caesarean section, representing a 20% increase in just 4 years. 4,5 In the private sector, caesarean section rates are over 80%. 6,7 Reasons for increasing caesarean section rates are under investigation. Several contributing factors from both the health provider and user sides have been identified, including fear of labour pain, misconceptions about vaginal delivery, previous traumatic births, social values, personal preferences, fear of litigation, economic reasons, and convenience for both patients and doctors. [8][9][10][...

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Section: Discussionmentioning

confidence: 99%

Googling caesarean section: a survey on the quality of the information available on the Internet

Fioretti

Reiter

Betrán

et al. 2014

BJOG: Int J Obstet Gy

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“…2 Despite this prevalence, very few cohort studies have examined the incidence of depressive disorders in this setting. Some have assessed incidence using physicians' case reports or retrospective reviews of medical records for case identification 3,4 ; however, systematic reviews have shown that roughly 50% of depressive disorders are missed in primary care 5 ; hence, such estimates may exclude patients who have not been identified as having depression by a physician. One way to overcome this issue is by using patient self-reported symptoms for case finding.…”

Section: Introductionmentioning

confidence: 99%

The 12-Month Incidence and Predictors of PHQ-9-Screened Depressive Symptoms in Chinese Primary Care Patients

Chin

Wan

Choi

et al. 2016

The Annals of Family Medicine

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PURPOSE Evidence regarding the onset of depressive symptoms in primary care is rarely available but can help inform policy development, service planning, and clinical decision making. The objective of this study was to estimate the 12-month cumulative incidence and predictors of a positive screen for depressive symptoms on the 9-item Patient Health Questionnare-9 (PHQ-9) among primary care patients with no history of physician-diagnosed depression. METHODSWe monitored a cohort of 2,929 adult primary care patients with no past history of physician-diagnosed depression and with baseline PHQ-9 scores of 9 or lower by telephone interview at 3, 6, and 12 months. A generalized linear mixed effects Poisson Model was used to explore factors associated with the incidence of PHQ-positive symptoms. RESULTSThe cumulative incidence of positive screening on the PHQ-9 over 12 months was 5.23% (95% CI, 3.83%-6.64%). Positive predictors included being female, coming from a lower-income household, being a smoker, having at least 2 comorbidities, having a family history of depression, and having consulted a physician at least twice in the past 4 weeks. Consulting a physician with qualifications in both family medicine and psychological medicine was a negative predictor. CONCLUSIONSThe cumulative incidence of PHQ-9-screened depressive symptoms in this study population was higher than those reported for depressive disorders in earlier systematic reviews. Groups who may warrant greater treatment attention include women, patients with multimorbidity, smokers, patients with recent high rates of medical consultations, and those who are from lower-income households or who have a family history of depression. Greater physician training may have a protective effect.

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“…4 Suboptimal levels of recognition and treatment are due to a variety of physician, health system, and patient factors. [4][5][6][7] The present study is part of the formative research of a larger project that will develop and evaluate offi ce-based interventions to encourage seeking care for depression. This research is grounded in a model that assumes self-disclosure of depression is a key step on the road to appropriate diagnosis and therapy.…”

Section: Introductionmentioning

confidence: 99%

Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care

Bell

Franks

Duberstein

et al. 2011

The Annals of Family Medicine

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PURPOSE Depression symptoms are underreported by patients. We thus assessed individuals' reasons for not disclosing depression to their primary care physician. METHODSWe conducted a follow-up telephone survey of 1,054 adults who had participated in the California Behavioral Risk Factor Survey System. Respondents were asked about reasons for nondisclosure of depressive symptoms to their primary care physician, depression-related beliefs, and demographic characteristics. Descriptive and inferential statistical procedures were used to characterize perceived obstacles to disclosure. RESULTSOf the respondents, 43% reported 1 or more reasons for nondisclosure. The most frequent reason was the concern that the physician would recommend antidepressants (22.9%; 95% confi dence interval, 18.8%-27.5%). Reported reasons for nondisclosure of depression varied based on whether the respondent had a history of depression. For example, respondents with no depression history were more likely to believe that depression falls outside the purview of primary care (P = .040) and more likely to fret about being referred to a psychiatrist (P = .036). Respondents with clinically signifi cant depressive symptoms rated 10 of 11 barriers to disclosure as more personally applicable than did those without symptoms (all P values ≤.014). Number of reported disclosure barriers was predicted by demographic characteristics (being female, Hispanic, of low socioeconomic status), depression beliefs (depression is stigmatizing and should be under one's control), symptom severity, and absence of a family history of depression.CONCLUSIONS Many adults subscribe to beliefs likely to inhibit explicit requests for help from their primary care physician during a depressive episode. Interventions should be developed to encourage patients to disclose their depression symptoms and physicians to ask about depression. Ann Fam Med 2011;9:439-446. doi:10.1370/afm.1277. INTRODUCTIONL ifetime and 12-month prevalence of major depressive disorder (MDD) in the United States has been estimated to be 16.2% and 6.6%, respectively.1 In one-fourth of primary care patients with MDD, the condition is not diagnosed, 1 and a majority who seek help from a primary care physician do not receive appropriate treatment.2,3 Because patients are often treated in primary care, 3 efforts have been made to improve recognition, treatment, and follow-up for patients with depression in general practice. 4 Suboptimal levels of recognition and treatment are due to a variety of physician, health system, and patient factors. 4-7The present study is part of the formative research of a larger project that will develop and evaluate offi ce-based interventions to encourage seeking care for depression. This research is grounded in a model that assumes self-disclosure of depression is a key step on the road to appropriate diagnosis and therapy. Physicians are more likely to initiate treatment when the patient provides recognizable clues to depression, 8 discloses symptoms of depression, or dire...

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

Cited by 50 publications

References 28 publications

Googling caesarean section: a survey on the quality of the information available on the Internet

Googling caesarean section: a survey on the quality of the information available on the Internet

The 12-Month Incidence and Predictors of PHQ-9-Screened Depressive Symptoms in Chinese Primary Care Patients

Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care

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