Elsevier

Women's Health Issues

Volume 26, Issue 5, September–October 2016, Pages 529-536
Women's Health Issues

Mental Health
Disclosure of Depression in Primary Care: A Qualitative Study of Women’s Perceptions

https://doi.org/10.1016/j.whi.2016.07.002Get rights and content

Abstract

Background

Health care providers are better able to diagnose depression and initiate treatment when patients disclose symptoms. However, many women are reluctant to disclose depressive symptoms. Little is known about the experience of disclosing depression symptoms in primary care among racially and ethnically diverse women across the life course. We qualitatively explore experiences of disclosure of depressive symptoms to primary care providers among self-identified African American, Hispanic and non-Hispanic White women.

Methods

Twenty-four women with depression were recruited for open-ended interviews. We recorded, transcribed, and coded interviews using inductive content analysis.

Findings

Two distinct domains emerged: participant factors that hinder and facilitate disclosure and provider cues that encourage and dissuade discussing depression. Participants described perceptions about primary care not being the appropriate place, fear of not having a choice in treatment decisions, and the emotional cost of retelling as impediments to disclosure; perceiving an increased likelihood of getting help was described as a facilitator. Women identified provider behaviors of asking about depression and showing concern as facilitators, and provider time constraints as a barrier to disclosure.

Conclusions

Women perceive that primary care is not the appropriate place to disclose depression symptoms. Increased public education about behavioral health management in primary care, as well as more robust integration of the two, is needed. Efforts to improve depression disclosure in primary care must also encompass systematic use of depression screening tools and implementation of targeted interventions to cultivate provider empathy.

Section snippets

Study Participants

We conducted semistructured interviews with a convenience sample of English-speaking African American, Hispanic, and non-Hispanic White women. Women were age 18 and older and reported a current or previous diagnosis of depression or met diagnostic criteria for current depression (score ≥ 10) based on the eight-item Patient Health Questionnaire depression scale (PHQ-8; Kroenke et al., 2009). The PHQ-8 includes eight of the nine DSM-5 diagnostic criteria for the diagnosis of depression. It is

Study Participants

Thirty-four women responded to recruitment efforts; 31 were eligible, 28 were scheduled for interviews, and 24 interviews were completed (10 White, 9 African American, and 5 Hispanic). Participants were between the ages of 18 and 58 years (mean, 40), and their PHQ-8 scores ranged from 3 to 24 (mean, 14.7; scores ≥10 identify current depression; Table 1). Of the 24 women interviewed, 20 (83%) met the diagnostic criteria for current depression using the PHQ-8. The PHQ-8 scores for the four women

Acknowledgments

This project was supported by the National Center for Advancing Translational Sciences (grant number UL1TR000427) and the National Institute on Minority Health and Health Disparities (grant number 5P60MD003428) of the National Institutes of Health (NIH), NIH/National Institute of Child Health and Human Development Kirschstein-National Research Service Award (grant number T32HD049302-06), and the NIH Loan Repayment Program for Health Disparities Research (grant number L60 MD008863). Additional

Abiola O. Keller, PA-C, MPH, PhD, is an Assistant Professor at the College of Health Sciences at Marquette University. Her research focuses on improving women's health through studying patient–provider interactions and associated outcomes.

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    • Abiola O. Keller, PA-C, MPH, PhD, is an Assistant Professor at the College of Health Sciences at Marquette University. Her research focuses on improving women's health through studying patient–provider interactions and associated outcomes.

    Carmen R. Valdez, PhD, is an Associate Professor in the Department of Counseling Psychology at the University of Wisconsin-Madison. Her research examines the impact of family stress and sociocultural context on outcomes for Latino children.

    Rebecca J. Schwei, MPH, is an Assistant Researcher at the University of Wisconsin. Her research interests include health disparities, provision of linguistically appropriate health care, and the social determinants of health.

    Elizabeth A. Jacobs, MD, MPP, is a Professor of Medicine and Population Health Sciences at the University of Wisconsin-Madison. Her research interests include access to and cultural specificity of care, impact of interpreter service interventions on health care, and health literacy and numeracy.

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    © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc.