Many patients hide depression from primary care doctors

Although primary care physicians are encouraged to ask patients about depressive symptoms, they should realize that some people are reluctant to admit they are depressed, a study says.

Reasons include concern about being considered a psychiatric patient, fear of becoming too emotional during the medical visit and hesitancy about divulging personal information to a physician, according to the study published online Sept. 12 in Annals of Family Medicine.

Study co-author Richard L. Kravitz, MD, MSPH, recommends that primary care physicians talk about the importance of discussing mental illness when they encounter patients who might be depressed. He also encourages doctors to place information about depression and screening in their waiting room and office.

This "sends a message that mental health care is a part of total health care, just like treating hypertension," said Dr. Kravitz, an internist and professor in the Dept. of Internal Medicine at the University of California Davis Health System in Sacramento, Calif. "Doctors are in a position to put their patients at ease" from the moment they walk into their practice, he said.

Nearly 7% of U.S. adults age 18 and older have depression, according to the Centers for Disease Control and Prevention. People were considered depressed if they had symptoms of moderate to severe depression in the two weeks before completing the CDC's 2005-08 National Health and Nutrition Examination Survey.

One in six Americans has been diagnosed with depression at some time, the Annals study said (link).

Researchers for the Annals study surveyed 1,054 adults 18 and older who participated in the 2008 California Behavioral Risk Factor Survey System. Participants were asked about depression, including their beliefs about the condition, whether they ever were treated for the illness and what they consider barriers to receiving treatment.

To measure perceived barriers, respondents were given 11 reasons why a patient might not talk to his or her primary care physician about depression. They were asked to rate each reason using the following scale: applies a lot to you, applies a little to you, or does not apply at all to you.

The study found that 43% of respondents reported that at least one barrier applied a lot to them. The most common barriers: patient concern about being prescribed antidepressants (23%); the belief that it is not a primary care physician's job to deal with emotional issues (16%); and uncertainty about the confidentiality of their medical records (15%).

Other worries reported by at least 10% of participants included concerns about being referred to a counselor or psychiatrist.

The study shows that participants with symptoms of moderate to severe depression were more likely to report that a barrier applies a lot to them than people with no symptoms or with mild depression symptoms.