Reasons for not disclosing symptoms of depression

January 01, 0001

Reasons for not disclosing symptoms of depression

Depression symptoms are underreported by patients. The researchers from the US thus assessed individuals’ reasons for not disclosing depression to their primary care physician. They 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.

Of 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%). 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 and more likely to fret about being referred to a psychiatrist. Respondents with clinically significant depressive symptoms rated 10 of 11 barriers to disclosure as more personally applicable than did those without symptoms. 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.

The researchers concluded: "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."

Definitely worth discussing with patients, but this study appears messy as it is about symptoms without the need for an established diagnosis, which suggests that the concerns may be realistic. Having life and income protection and disability cover from insurance companies on-side with regards to depression may also improve things.

For the full abstract, click here.

Annals of Family Medicine 9:439-446, September/October 2011 © 2011 Annals of Family Medicine
Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care. Robert A. Bell, Peter Franks, Paul R. Duberstein et al. Correspondence to Robert Bell: rabell@ucdavis.edu

Category: P. Psychological, HSR. Health Services Research. Keywords: depression, primary health care, disclosure, treatment, communication barriers, social stigma, telephone survey, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 14 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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