Journal of General Internal Medicine

, Volume 25, Issue 9, pp 954–961

“I Didn’t Know What Was Wrong:” How People With Undiagnosed Depression Recognize, Name and Explain Their Distress

  • Ronald M. Epstein
  • Paul R. Duberstein
  • Mitchell D. Feldman
  • Aaron B. Rochlen
  • Robert A. Bell
  • Richard L. Kravitz
  • Camille Cipri
  • Jennifer D. Becker
  • Patricia M. Bamonti
  • Debora A. Paterniti
Original Research

DOI: 10.1007/s11606-010-1367-0

Cite this article as:
Epstein, R.M., Duberstein, P.R., Feldman, M.D. et al. J GEN INTERN MED (2010) 25: 954. doi:10.1007/s11606-010-1367-0

Abstract

BACKGROUND

Diagnostic and treatment delay in depression are due to physician and patient factors. Patients vary in awareness of their depressive symptoms and ability to bring depression-related concerns to medical attention.

OBJECTIVE

To inform interventions to improve recognition and management of depression in primary care by understanding patients’ inner experiences prior to and during the process of seeking treatment.

DESIGN

Focus groups, analyzed qualitatively.

PARTICIPANTS

One hundred and sixteen adults (79% response) with personal or vicarious history of depression in Rochester NY, Austin TX and Sacramento CA. Neighborhood recruitment strategies achieved sociodemographic diversity.

APPROACH

Open-ended questions developed by a multidisciplinary team and refined in three pilot focus groups explored participants’ “lived experiences” of depression, depression-related beliefs, influences of significant others, and facilitators and barriers to care-seeking. Then, 12 focus groups stratified by gender and income were conducted, audio-recorded, and analyzed qualitatively using coding/editing methods.

MAIN RESULTS

Participants described three stages leading to engaging in care for depression — “knowing” (recognizing that something was wrong), “naming” (finding words to describe their distress) and “explaining” (seeking meaningful attributions). “Knowing” is influenced by patient personality and social attitudes. “Naming” is affected by incongruity between the personal experience of depression and its narrow clinical conceptualizations, colloquial use of the word depression, and stigma. “Explaining” is influenced by the media, socialization processes and social relations. Physical/medical explanations can appear to facilitate care-seeking, but may also have detrimental consequences. Other explanations (characterological, situational) are common, and can serve to either enhance or reduce blame of oneself or others.

CONCLUSIONS

To improve recognition of depression, primary care physicians should be alert to patients’ ill-defined distress and heterogeneous symptoms, help patients name their distress, and promote explanations that comport with patients’ lived experience, reduce blame and stigma, and facilitate care-seeking.

KEY WORDS

depressiondiagnosisinterventions

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Ronald M. Epstein
    • 1
    • 2
  • Paul R. Duberstein
    • 2
    • 3
  • Mitchell D. Feldman
    • 4
  • Aaron B. Rochlen
    • 5
  • Robert A. Bell
    • 6
  • Richard L. Kravitz
    • 7
    • 8
  • Camille Cipri
    • 8
  • Jennifer D. Becker
    • 2
  • Patricia M. Bamonti
    • 3
  • Debora A. Paterniti
    • 7
    • 8
    • 9
  1. 1.Departments of Family Medicine, Psychiatry and OncologyUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Rochester Center to Improve Communication in Health CareUniversity of Rochester Medical CenterRochesterUSA
  3. 3.Laboratory of Personality and Development, Department of PsychiatryUniversity of Rochester Medical CenterRochesterUSA
  4. 4.Division of General Internal Medicine, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  5. 5.Department of Educational PsychologyThe University of Texas at AustinAustinUSA
  6. 6.Department of Communication and Public Health SciencesUniversity of California, DavisDavisUSA
  7. 7.Department of Internal Medicine, Division of General MedicineUniversity of California Davis School of MedicineSacramentoUSA
  8. 8.Center for Healthcare Policy and ResearchUniversity of California Davis School of MedicineSacramentoUSA
  9. 9.Department of SociologyUniversity of California DavisDavisUSA