Depression in rural family practice. Easy to recognize, difficult to diagnose
J. L. Susman, B. F. Crabtree and G. Essink
Department of Family Practice, University of Nebraska Medical Center, Omaha, USA.
OBJECTIVE: To explore rural family physicians' decision-making processes
when they encounter depression. DESIGN: Exploratory qualitative "field
study" using individual in-depth interviews and participant observation.
Interviews were audiotaped, transcribed, and analyzed by an editing
approach. SETTING: Rural Nebraska family physicians' offices. PARTICIPANTS:
A purposeful sample of six rural Nebraska family physicians, including five
men and one woman, aged 35 to 65 years; two in solo practice, three in
two-person practices, and one in a group practice; in communities with
populations ranging from 600 to 6500. MAIN OUTCOME MEASURES: Themes common
to all interviews. RESULTS: Themes included the following: depression is
easy to recognize but difficult to diagnose; depression is readily
treatable but requires negotiation to manage; and depression is important
but time and resources are limited. The inadequate diagnosis and treatment
of depression appeared to be partly artifactual and must be understood
against a background of perceived stigma, high prevalence of depressive
symptoms, structural barriers to care, and context of rural practice.
CONCLUSIONS: Rural family physicians may have a more deliberate, organized,
and rational approach to depressive disorders than previously reported.
Depression is commonly recognized by rural family physicians; however, they
hesitate to diagnose this condition because of diagnostic uncertainty,
perceived stigma, the desire to preserve the physician-patient
relationship, time and financial pressures, and a lack of supporting
resources.
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