Why Patients Don’t Open Up to Doctors About Depression

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Would you feel comfortable confiding in your family doctor about symptoms of depression? For many Americans, the answer is no.

To determine why, a team of psychologists at the University of California, Davis, conducted a phone survey of 1,054 adults in California. Researchers inquired about a variety of barriers that might keep people from talking about depression with their doctors and assessed people’s beliefs about the disorder. Participants were also screened for current signs of depression and asked whether they had ever been treated for it in the past.

The researchers found that 43% of respondents said they had at least one reason for not telling their doctors about symptoms of depression. The most common reason, cited by 23% of those surveyed, was fear that their doctor would try to prescribe them antidepressant drugs.

Thirteen percent said they were worried they would be referred to a psychiatrist and 12% said they didn’t want to be considered a psychiatric patient. Further, 16% didn’t think psychological issues fell under the purview of a primary care doctor, and 15% were concerned about medical record confidentiality.

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The findings suggest that a variety of reasons contribute to patients’ hesitancy to open up about their psychiatric problems, and that may help explain why about a quarter of American primary care patients with major depressive disorder go undiagnosed.

In the study sample, respondents who showed signs of moderate to severe depression (a total 153 people) were more likely than people without depression to say that most of the reasons that researchers presented for withholding symptoms from doctors applied strongly to them.

“Ironically, those who most subscribed to potential reasons for not talking to a primary care physician about their depression tended to be those who had the greatest potential to benefit from such conversations,” wrote the researchers.

People who had previous depression didn’t report more reasons for not bringing up depressive symptoms with doctors, but their reasoning was different from those with no such mental-health history. People who had been treated for depression in the past tended to be more concerned about medical record privacy and losing emotional control during their doctor’s appointment. Those without a history of depression, in contrast, were more worried about being prescribed antidepressants or being referred to a psychiatrist and were more likely to believe it wasn’t a primary care doctor’s job to deal with depression.

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To help patients overcome these barriers to care, the authors are currently developing office-based interventions to encourage doctor-patient conversation about depression. The strategies include educational videos and multimedia to help combat stigma, as well as using questionnaires and explicit questions about depression from the doctor to start a dialogue. “It is clear that left to their own devices, many patients will not report important symptoms spontaneously,” the authors wrote.

The study was published in the Annals of Family Medicine.

Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.