“I Didn’t Know What Was Wrong:” How People With Undiagnosed Depression Recognize, Name and Explain Their Distress

Epstein, Ronald M.; Duberstein, Paul R.; Feldman, Mitchell D.; Rochlen, Aaron B.; Bell, Robert A.; Kravitz, Richard L.; Cipri, Camille; Becker, Jennifer; Bamonti, Patricia M.; Paterniti, Debora A.

doi:10.1007/s11606-010-1367-0

Cited by 80 publications

(71 citation statements)

References 35 publications

(43 reference statements)

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“…It might inhibit the older people from seeking treatments. This is in line with previous studies that reported that patients with depression did not seek treatment because they lacked knowledge (Epstein et al, 2010), and because they hide due to a feeling of shame (Holm & Severinsson, 2014). This study has shown that the older people feeling judged by surrounded people.…”

Section: Discussionsupporting

confidence: 92%

Older Thai Peoples’ Perceptions and Experiences of Major Depression

Kleebthong¹,

Chareonsuk²,

Kristiansen³

2017

GJHS

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Background: Depressive disorders are common mental health problems and may be disabling among the general older population. Although older people have significant symptoms of depression, the symptoms are likely to be underreported. The condition often co-exist along with somatic ill and has often been unrecognized. The aim of the study was to explore and understand the perceptions and experiences of older Thai people diagnosed with major depressive disorder. Methods:A qualitative inductive research design was used and latent content analysis was utilized. The data were collected through face-to-face, in-depth interviews. Fourteen older people diagnosed with major depressive disorder were selected for participant using purposive sampling. Findings:Older Thai peoples' perceptions and experiences of depression were abstracted into two themes. First theme was leading a life in detachment, which included three subthemes: living with meaninglessness, holding distress with one's self, and feeling judged by surrounded people. The second theme was inconvenience of approaching mental health treatment, which included two subthemes: sensing an unapproachable health care service, and lacking knowledge about clinical depression. Conclusion:Older Thai peoples' perceptions and experiences of major depression were affected with high level suspected existential loneliness that might even be worse in a collect oriented society as in the Thai context. Further, it seem hard to approach the mental health care. The central reason for this is interpreted as lack of mental health literacy, and in this case, specifically, knowledge on depression. Future studies should focus on relatives' experiences of living with an older family member that suffered from major depression, and on the state of mental health literacy in the rural Thai population.

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Section: Discussionsupporting

confidence: 92%

Older Thai Peoples’ Perceptions and Experiences of Major Depression

Kleebthong¹,

Chareonsuk²,

Kristiansen³

2017

GJHS

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“…Fifth, we did not address the needs of those who may have been willing to request help but failed to recognize that their symptoms could be indicative of depression. 13 In this survey from California, 43% of patients strongly endorsed one or more reasons for not disclosing depression to their primary care physician. This fi nding underscores the need to develop and test offi ce-based interventions that address these patient concerns and motivate disclosure of depression.…”

Section: Discussionmentioning

confidence: 85%

“…32,33 Not surprisingly, holding self-blaming attributions about depression and believing that one should be able to control one's own symptoms of depression are associated with unwillingness to discuss depressive symptoms with physicians. 13 Interestingly, having a family member or friend who had gone through depression was associated with fewer perceived obstacles to care, but having a personal history of depression was not. 34 Future studies should consider how vicarious and personal experiences foster different expectations about the process and outcomes of depression care.…”

Section: Discussionmentioning

confidence: 99%

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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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“…Despite the public health burden of depression (1–6) and the public’s increased willingness (7) to seek effective treatments (2,8), many factors continue to act as significant barriers to treatment seeking (9–15), particularly for men (16–19). Structural barriers, such as limitations on insurance coverage and availability of providers, are important obstacles to help seeking (20), but attitudinal barriers, such as stigma and social norms, are important impediments as well and are arguably more amenable to intervention.…”

mentioning

confidence: 99%

Role of the Gender-Linked Norm of Toughness in the Decision to Engage in Treatment for Depression

O'Loughlin

Duberstein

Bell

et al. 2011

Psychiatric Services

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Objective Given their prevalence and persuasive power in our culture, gender norms— commonly described as socially reinforced, learned expectations of what it means to be a man or a woman—likely contribute to sex differences in service utilization for depression. This study investigated whether sex differences in toughness, a gender-linked norm characterized by a desire to hide pain and maintain independence, were associated with a preference to wait for depression to resolve on its own without active professional treatment (``wait-and-see” approach). Methods Participants (N=1,051) in the California Behavioral Risk Factor Surveillance System (BRFSS) survey were contacted in a follow-on survey to assess toughness, the kind of treatment they would prefer were they to receive a diagnosis of depression, and current symptoms of depression. Participants who reported ever having been diagnosed as having a depressive disorder on the BRFSS were oversampled threefold. Analyses were conducted using linear and logistic regressions. Results Men and women who scored higher on toughness had a greater preference for the wait-and-see approach (OR=1.14, p<.01). Women were less likely to prefer the wait-and-see approach (OR=.58, p<.04) and scored lower on toughness (B=−.70, p<.01). Men’s greater levels of toughness partially mediated the sex difference in treatment preferences (OR=.91, p<.05). Conclusions Men’s greater adherence to the toughness norm explained part of the sex difference observed in treatment-seeking preferences, but toughness undermined women’s treatment seeking as well. Findings could be used to inform novel public health communications intended to attract both men and women to psychiatric services.

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“I Didn’t Know What Was Wrong:” How People With Undiagnosed Depression Recognize, Name and Explain Their Distress

Cited by 80 publications

References 35 publications

Older Thai Peoples’ Perceptions and Experiences of Major Depression

Older Thai Peoples’ Perceptions and Experiences of Major Depression

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

Role of the Gender-Linked Norm of Toughness in the Decision to Engage in Treatment for Depression

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