BARRIERS TO THE DIAGNOSIS OF DEPRESSION IN PRIMARY-CARE

Approximately 50% of people treated for depression receive treatment i n primary care settings. However, studies have demonstrated that speci fic factors interfere with recognition of this disorder in the primary care setting and decrease the likelihood of an accurate diagnosis. Va riables that relate to the patient include lack of awareness and under standing of the nature of the disease and its symptoms so that they ca n be accurately reported to the physician. Variability in clinical pre sentation and the presence of comorbid medical disorders also make det ection difficult. Complaints of physical symptoms confuse the clinical picture. In addition, patients are ashamed to admit to psychological symptoms of depression and fear the stigma attached to it. Interfering factors that relate to the physician include a lack of knowledge abou t the disease and lack of training in its management that reduce the p hysician's ability to render a diagnosis and undermine confidence in t he capacity to treat the illness successfully. Reluctance on the part of the physician to inquire frankly about depression also plays a role . Barriers that stem from the system include financing of care under c apitated systems, other reimbursement issues, time available to care f or patients, and continuity of the physician/patient relationship. A v ariety of tools are available to assist primary care physicians in the recognition and accurate diagnosis of depression. Use of these tools would increase the recognition and effective management of depression.