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Relational barriers to depression help-seeking in primary care
Richard L Kravitz1, Debora A Paterniti, Ronald M Epstein
1Department of Internal Medicine, Division of General Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA. rlkravitz@ucdavis.edu
Patient Education and Counseling
|June 24, 2010
Summary
Patients with depression face barriers seeking care due to concerns about primary care physician (PCP) competence and trust. Improving PCP mental health skills and public education is crucial for effective depression treatment.
Area of Science:
- Mental Health Research
- Primary Care Medicine
- Sociology of Health
Background:
- Depression care-seeking and disclosure present challenges within primary care settings.
- The primary care paradigm for mental health requires evaluation in the United States.
Purpose of the Study:
- To identify attitudinal and interpersonal barriers to depression care-seeking and disclosure in primary care.
- To evaluate the effectiveness of the primary care model for depression management.
Main Methods:
- Qualitative focus group interviews were conducted with 15 groups across three cities.
- Participants included English-speaking adults aged 25-64 with direct experience of depression.
- Iterative thematic analysis was applied to interview transcripts.
Main Results:
- Participants expressed doubts regarding primary care physicians' (PCPs) ability to address mental health needs.
- Barriers included perceived PCP competence, openness, and patient-physician trust.
- Low-income participants emphasized the critical, yet vulnerable, nature of patient-PCP trust.
Conclusions:
- Relational barriers, such as perceptions of PCP capabilities and interest in mental health, deter patients from seeking or disclosing depression.
- Primary care physicians (PCPs) need enhanced depression management skills.
- Public information campaigns are needed to establish primary care as a suitable setting for mental health treatment.
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