The Recognition of Depression: The Primary Care Clinician's Perspective

Abstract

PURPOSE The purpose of this study was to explore the responses of primary care clinicians to patients who complain of symptoms that might indicate depression, to examine the clinical strategies used by clinicians to recognize depression, and to identify the conditions that infl uence their ability to do so. METHODSThe grounded theory method was used for data collection and analysis. In-depth, in-person interviews were conducted with a purposeful sample of 8 clinicians. All interviews were audiotaped and transcribed.RESULTS This study identifi ed 3 processes clinicians engage in to recognize depression-ruling out, opening the door, and recognizing the person-and 3 conditions-familiarity with the patient, general clinical experience, and time availability-that infl uence how each of the processes is used. CONCLUSIONSThe likelihood of accurately diagnosing depression and the timeliness of the diagnosis are highly infl uenced by the conditions within which clinicians practice. Productivity expectations in primary care will continue to undermine the identifi cation and treatment of depression if they fail to take into consideration the factors that infl uence such care.

Primary Care Clinicians’ Recognition and Management of Depression: A Model of Depression Care in Real-World Primary Care Practice

“…To describe the comprehensive model succinctly, processes and conditions are grouped into four depression care stages identified in the data: recognition ( Fig. 1), between recognition and initial treatment ( The Recognition of Depression: Figure 1 This study confirmed previously identified three processes (ruling out, opening the door, and recognizing the person) and three conditions (time, experience, and familiarity with the patient) 59 and dimensions of clinical experience that result in provider comfort, a potential mediating variable, in depression care. 60 Two other previously identified conditions (lack of objective evidence and stigma) were refined as clinical-related or system-related and society-related conditions, respectively.…”

“…46 Consistent with those findings, we discovered that time constraints hindered even experienced clinicians' ability to deliver depression care, even with familiar patients. 58,59 Depression care quality interventions to date have tended to focus on larger practices that comprise about one-fourth of US PC practices. The other three-fourths of PC practices are individual or small group practices with scarcer resources.…”

A comparative study of different classifiers for detecting depression from spontaneous speech

“…Major depression is the leading cause of disability and the cause of more than two-thirds of suicides each year [1]. Therefore, failure to diagnose depression in primary care is a critical public health problem that results in high societal costs related to disability, morbidity, mortality, and excessive health care utilisation [2]. Moreover, effective depression treatment is limited by current assessment methods that rely almost exclusively on patient-reported or clinical judgements of symptom severity [3], risking a range of subjective biases.…”

Diagnosing Mental Health Disorders in Primary Care: Evaluation of a New Training Tool

“…Physicians may use different diagnostic approaches, such as considering depression only after ruling out all possible medical diagnoses, and using antidepressants to rule in depression (Baik et al, 2005;Carney et al, 1998).…”

“…Barriers to effective recognition of mental health disorders by PCPs include: "inadequate knowledge of the diagnostic criteria, uncertainty about the best questions to ask to evaluate whether those criteria are met, and time limitations inherent in a busy office setting" (Spitzer et al, 1994(Spitzer et al, , p. 1749. Many research studies have been conducted in order to understand, assess, and treat these disorders (American Family Physician, 2000;Baik et al, 2005;Cabana et al, 2002;CTPTSD, 2007;Grinage, 2003;Kessler et al, 2005;Lecrubier, 2004;Louch, 2009;Olfson et al, 2005;Pratt & Brody 2008;Staub, 2001), but few studies have examined the use of avatar technology to aid in the training of assessment and diagnosis of these disorders (Kenny et al, 2008;Satter et al, 2012;Triola et al, 2006). This research focused on evaluating computerbased training tools (Avatars) for training family physicians to better diagnose MDD and PTSD.…”