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Title: Latvian family physicians’ experience diagnosing depression in somatically presenting depression patients : A qualitative study
Authors: Leff, Maija S.
Vrubļevska, Jeļena
Lūse, Agita
Rancāns, Elmārs
Department of Psychiatry and Narcology
Department of Communication Studies
Keywords: Depression;Diagnosis;General practice;Qualitative methods;Unexplained somatic complaints;3.2 Clinical medicine;1.1. Scientific article indexed in Web of Science and/or Scopus database;Family Practice
Issue Date: 2-Oct-2017
Citation: Leff , M S , Vrubļevska , J , Lūse , A & Rancāns , E 2017 , ' Latvian family physicians’ experience diagnosing depression in somatically presenting depression patients : A qualitative study ' , European Journal of General Practice , vol. 23 , no. 1 , pp. 91-97 .
Abstract: Background: Depression continues to be under-diagnosed in primary care settings. One factor that influences physicians’ likelihood of diagnosing depression is patients’ presentation style. Patients who initially present with somatic symptoms are diagnosed at a lower rate and with greater delay than patients who present with psychosocial complaints. Objectives: To identify the barriers preventing depression diagnosis in somatically presenting patients in an Eastern European primary care setting. Methods: Thematic analysis of semi-structured interviews with 16 family physicians (FPs) in Latvia. FPs were sampled using a maximum variation strategy, varying on patient load, urban/ rural setting, FP gender, presence/absence of on-site mental health specialists, and FP years of practice. Results: FPs observed that a large subgroup of depression patients presented with solely somatic complaints. FPs often did not recognize depression in somatically presenting patients until several consultations had passed without resolution of the somatic complaint. When FPs had psychosocial information about the somatically presenting patient, they recognized depression more quickly. Use of depression screening questionnaires was rare. Barriers to diagnosis continued beyond recognition. Faced with equivocal symptoms that undermined clinical certainty, FPs postponed investigating their clinical suspicion that the patient had depression and pursued physical examinations that delayed depression diagnosis. FPs also used negative physical examination results to convince reluctant patients of a depression diagnosis. Conclusion: Delayed recognition, the need to rule out physical illness, and the use of negative physical examination results to discuss depression with patients all slowed the path to depression diagnosis for somatically presenting patients in Latvian primary care.
Description: Funding Information: This project was funded by a Fulbright Program grant sponsored by the Bureau of Educational and Cultural Affairs of the United States Department of State and administered by the Institute of International Education. Publisher Copyright: © 2017 The Author(s).
ISSN: 1381-4788
Appears in Collections:Research outputs from Pure / Zinātniskās darbības rezultāti no ZDIS Pure

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