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Disclosure of Depression in Primary Care: A Qualitative Study of Women’s Perceptions

Published:August 13, 2016DOI:https://doi.org/10.1016/j.whi.2016.07.002

      Abstract

      Background

      Health care providers are better able to diagnose depression and initiate treatment when patients disclose symptoms. However, many women are reluctant to disclose depressive symptoms. Little is known about the experience of disclosing depression symptoms in primary care among racially and ethnically diverse women across the life course. We qualitatively explore experiences of disclosure of depressive symptoms to primary care providers among self-identified African American, Hispanic and non-Hispanic White women.

      Methods

      Twenty-four women with depression were recruited for open-ended interviews. We recorded, transcribed, and coded interviews using inductive content analysis.

      Findings

      Two distinct domains emerged: participant factors that hinder and facilitate disclosure and provider cues that encourage and dissuade discussing depression. Participants described perceptions about primary care not being the appropriate place, fear of not having a choice in treatment decisions, and the emotional cost of retelling as impediments to disclosure; perceiving an increased likelihood of getting help was described as a facilitator. Women identified provider behaviors of asking about depression and showing concern as facilitators, and provider time constraints as a barrier to disclosure.

      Conclusions

      Women perceive that primary care is not the appropriate place to disclose depression symptoms. Increased public education about behavioral health management in primary care, as well as more robust integration of the two, is needed. Efforts to improve depression disclosure in primary care must also encompass systematic use of depression screening tools and implementation of targeted interventions to cultivate provider empathy.
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      Biography

      Abiola O. Keller, PA-C, MPH, PhD, is an Assistant Professor at the College of Health Sciences at Marquette University. Her research focuses on improving women's health through studying patient–provider interactions and associated outcomes.

      Biography

      Carmen R. Valdez, PhD, is an Associate Professor in the Department of Counseling Psychology at the University of Wisconsin-Madison. Her research examines the impact of family stress and sociocultural context on outcomes for Latino children.

      Biography

      Rebecca J. Schwei, MPH, is an Assistant Researcher at the University of Wisconsin. Her research interests include health disparities, provision of linguistically appropriate health care, and the social determinants of health.

      Biography

      Elizabeth A. Jacobs, MD, MPP, is a Professor of Medicine and Population Health Sciences at the University of Wisconsin-Madison. Her research interests include access to and cultural specificity of care, impact of interpreter service interventions on health care, and health literacy and numeracy.