scholarly journals “Doctor, my back hurts and I cannot sleep.” Depression in primary care patients: Reasons for consultation and perceived depression stigma

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248069
Author(s):  
Ines Heinz ◽  
Sabrina Baldofski ◽  
Katja Beesdo-Baum ◽  
Susanne Knappe ◽  
Elisabeth Kohls ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Pharmacological Treatment ◽  
Physical Symptoms ◽  
Perceived Stigma ◽  
Related Factors ◽  
Adequate Treatment ◽  
Depression Diagnosis ◽  
Mental Symptoms ◽  
Primary Care Patients

Background General practitioners (GPs) play a significant role in depression care. Recognition of depression is crucial for adequate treatment but is impeded by a high portion of depressed patients only reporting physical symptoms to their GP. Among the many reasons for this phenomenon is mental health stigma. We investigated how patients with depression differed from patients without depression regarding the types and number of complaints presented to their GP, as well as their depression stigma. For the subgroup of patients with depression, potential associations between perceived depression stigma and number and types of presented complaints were investigated to see if these might reflect the patient’s intention to conceal mental health symptoms due to fear of being stigmatized by others. Further, we investigated if perceived depression stigma is related to depression treatment. Methods Data on depressive symptoms (assessed by the Depression Screening Questionnaire; DSQ), depression stigma (assessed by the Depressions Stigma Scale; DSS), type of complaints reported to the GP and treatment-related factors were collected from 3,563 unselected primary care patients of 253 GPs in a cross-sectional epidemiological study (“VERA study”) in six different German regions. Data of a total of 3,069 patients was used for analysis on complaints reported to the GP (subsample of the VERA study), and for 2,682 out of 3,069 patients data on a stigma questionnaire was available. Results Nearly half of the primary care patients with depression (42.2%) reported only physical complaints to their GP. Compared to patients without a depression diagnosis, patients with depression reported twice as many complaints to their GP with a mean of 2.02 (1.33) vs. 1.2 (0.69), including a more frequent combination of physical and mental symptoms (28.8% vs. 3.5%). Patients with depression showed higher total stigma compared to patients without depression, Mdn = 48 (IQR 40–54) vs. Mdn = 46.3 (IQR 29–53), due to higher perceived stigma, Mdn = 27 (IQR 21–32) vs. Mdn = 25.9 (IQR 20–29). Perceived stigma was associated with male gender (beta -.14, p = .005) and a lack of pharmacological treatment (beta -.14, p = .021) in patients with a depression diagnosis. Conclusion The number of complaints presented to the GP might function as a marker to actively explore depression in primary care patients, in particular when both physical and mental symptoms are reported. Perceived depression stigma should also be addressed especially in male patients. Further research should clarify the role of perceived stigma as a potential inhibitor of pharmacological treatment of depression in primary care.

Integrating Clinical Nurse Specialists into the Treatment of Primary Care Patients with Depression

2003 ◽  
Vol 33 (1) ◽  
pp. 17-37 ◽  
Author(s):  
Ralph W. Swindle ◽  
Jaya K. Rao ◽  
Ahdy Helmy ◽  
Laurie Plue ◽  
X. H. Zhou ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Integrated Care ◽  
Medical Center ◽  
Treatment Plan ◽  
Intervention Group ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
Primary Care Patients

Objective: To examine the effectiveness of integrating generalist and specialist care for veterans with depression. Method: We conducted a randomized trial of patients screening positive for depression at two Veterans Affairs Medical Center general medicine clinic firms. Control firm physicians were notified prior to the encounter when eligible patients had PRIME-MD depression diagnoses. In the intervention firm, a mental health clinical nurse specialist (CNS) was to: design a treatment plan; implement that plan with the primary care physician; and monitor patients via telephone or visits at two weeks, one month and two months. Primary outcomes (depressive symptoms, patient satisfaction with health care) were collected at 3 and 12 months. Results: Of 268 randomized patients, 246 (92%) and 222 (83%) completed 3- and 12-month follow-up interviews. There were no between-group differences in depressive symptoms or satisfaction at 3 or 12 months. The intervention group had greater chart documentation of depression at baseline (63% versus 33%, p = 0.003) and a higher referral rate to mental health services at 3 months (27% versus 9%, p = 0.019). There was no difference in the rate of new prescriptions for, or adequate dosing of, anti-depressant medications. In 40% of patients, CNSs disagreed with the PRIME-MD depression diagnosis, and their rates of watchful waiting were correspondingly high. Conclusions: Implementing an integrated care model did not occur as intended. Experienced CNSs often did not see the need for treatment in many primary care patients identified by the PRIME-MD. Integrating integrated care models in actual practice may prove challenging.

Primary Care Patients' Reactions to Mental Health Screening

1996 ◽  
Vol 26 (4) ◽  
pp. 431-441 ◽  
Author(s):  
Mark Zimmerman ◽  
David T. Lush ◽  
Neil J. Farber ◽  
Jon Hartung ◽  
Gary Plescia ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Psychiatric Treatment ◽  
Primary Care Clinic ◽  
Empirical Support ◽  
Medical Patients ◽  
Care Clinic ◽  
History Of ◽  
Primary Care Patients ◽  
High Level

Objective: The authors examined whether there is empirical support for the notion that medical patients are upset by being asked questions about psychiatric disorders. Method: Six hundred and one patients attending a primary care clinic completed the SCREENER—a newly developed, brief self-administered questionnaire that surveys a broad range of psychopathology. In addition, they completed a second questionnaire that assessed their attitudes toward the SCREENER. Results: We found a high level of acceptance by patients. The questions were judged easy to answer, and they rarely aroused significant negative affect. Fewer than 2 percent of the patients judged the questions difficult to answer, and fewer than 3 percent were “very much” embarrassed, upset, annoyed, or uncomfortable with the questions. Individuals with a history of psychiatric treatment and poorer current mental health reacted more unfavorably to the questionnaire. Conclusions: From the patient's perspective, it is feasible and acceptable to use self-administered questionnaires for routine screening of psychiatric problems in primary care settings.

scholarly journals Unmet Mental Health Need Among Chinese and Latino Primary Care Patients: Intersection of Ethnicity, Gender, and English Proficiency

2019 ◽  
Vol 35 (4) ◽  
pp. 1245-1251 ◽  
Author(s):  
Maria E. Garcia ◽  
Ladson Hinton ◽  
Steven E. Gregorich ◽  
Jennifer Livaudais-Toman ◽  
Celia Kaplan ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
English Proficiency ◽  
Primary Care Patients ◽  
Health Need ◽  
Unmet Mental Health

Does patient–provider gender concordance affect mental health care received by primary care patients with major depression?

2006 ◽  
Vol 16 (3) ◽  
pp. 122-132 ◽  
Author(s):  
Kitty S. Chan ◽  
Chloe E. Bird ◽  
Robert Weiss ◽  
Naihua Duan ◽  
Lisa S. Meredith ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Major Depression ◽  
Mental Health Care ◽  
Gender Concordance ◽  
Primary Care Patients
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