Communication key to diagnosing depression

December 14, 1999

Communication skills training may help doctors recognize patients who are suffering from depression, a condition that is often missed at the primary care level, according to a new study.

"Although many individuals with depression want help from primary care physicians, these physicians may fail to recognize depression or may undertreat it when recognized," said lead study author Martha S. Gerrity, MD, PhD, Oregon Health Sciences University. "Physicians who ask about psychosocial issues, use open-ended questions, and allow more time for the patient to talk are more likely to recognize depression."

Depression, which is thought to be responsible for approximately 25 percent of health care center visits worldwide, can severely reduce quality of life and productivity.

Gerrity and colleagues enlisted approximately 50 Portland, Oregon-based physicians to participate in their study. Physicians gave informed consent to participate in the study and knew that they would be visited by actors posing as patients, but they did not know when. Half of the physicians were given eight hours of communication skills training, and all physicians received office visits from two individuals posing as depressed patients during the six-week study period.

The physicians who received the communication skills training were better able to recognize depression in two actors posing as depressed patients, the researchers found. The results of the study appear in the December issue of The Journal of Family Practice.

The communication skills training was part of the Depression Education Program developed by Gerrity and colleagues from the Long Island Jewish Medical Center in New Hyde Park, New York, and Dartmouth Medical School, in Hanover, New Hampshire.

The program, which trains physicians to recognize depression, to differentiate chronic depression from minor depression, to manage medication prescription, and to communicate and negotiate with patients, might be an effective continuing medical education program for physicians, according to the researchers.

More of the physicians who received the communication skills training asked about stresses at home, involved patients in decision-making processes, discussed the possibility of depression, and scheduled a return visit within two weeks, Gerrity and colleagues found.

The actor "patients" were trained to present depressive symptoms in a masked way, since patients often neglect to mention depression to their physicians. A female actor posed as a 64-year-old patient with abdominal pain, who if asked, admitted to depressive symptoms such as appetite loss, feelings of guilt, difficulty concentrating, insomnia, and fatigue. A male actor posed as an agitated 63-year-old patient with chest pain, who if asked, admitted to similar symptoms, including irritability.

The actors were instructed to express surprise if the doctor mentioned depression and to hesitate to accept a diagnosis of depression. "Reluctance to accept diagnosis, begin treatment with medications, or accept referral to a mental health specialist are major barriers to physicians' care of patients with depression," said Gerrity.

"Overcoming patient reluctance and negotiating an appropriate treatment plan require good communication skills," said Gerrity.
Grant support for this study was provided by the John D. and Catherine T. MacArthur Foundation's Initiative on Depression in Primary Care.

The Journal of Family Practice is a monthly peer-reviewed scientific journal specifically intended to meet the needs of the specialty of Family Medicine. The journal provides the practicing and research communities of family physicians with a broad range of scholarly work in the discipline. For information on the journal contact Paul A. Nutting, MD, MSPH, at 303-407-1704.

Posted by the Center for the Advancement of Health <>. For information about the Center, call Petrina Chong, <> 202-387-2829.

Center for Advancing Health

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