Influence of symptom attribution on reporting depression and recourse to treatment

A Bristol general practice study demonstrated the extent to which patients' attribution style influences psychological diagnostic case rates. We pursue this issue and several implications in this Australian study.

A survey was undertaken of six general practices in Sydney, and involving more than 900 routine general practice patients. Subjects completed questionnaires assessing personality styles observed in those with clinical depression, attributional response (i.e. 'psychological', 'somatic' and 'normalizing') to three somatic cues, state depression, lifetime depression, use of antidepressant medication, and recourse to professional help.

Responders attributing psychological explanations to the somatic cues had the highest state and lifetime depression rates, viewed their depression as more likely to be a 'disorder' and were more likely to have received treatment for depression. Those with a personality style of 'anxious worrying' reported increased morbidity across all depression variables, but personality did not make attributional style redundant in multivariate analyses.

Interpreting somatic cues in a psychological way is associated with higher rates of reported depression and increased recourse to depression treatment. Thus, a normalizing response style may make depression recognition and detection difficult. Study findings challenge the capacity of self-report measures to detect depression, especially in general practice settings.