Questions about feelings help uncover depression

December 14, 1999

Physicians who are more communicative with patients and who ask more questions about patients' feelings appear more successful in diagnosing depression, according to a new study.

Depression is thought to be under-recognized by physicians, because of factors such as inadequate training, patient and physician attitudes, and health care system issues such as insufficient time and reimbursement.

"One area that has received relatively little attention is how physician-patient communication influences recognition of depression in a primary care practice," said lead study author Patricia A. Carney, PhD, of Dartmouth Medical School in Lebanon, New Hampshire. "To identify how best to assist primary care physicians in overcoming the complicated obstacles that hinder recognizing depression, the communications process must be better understood."

To evaluate how physicians' communication abilities affected their recognition of depression, Carney and colleagues had actors posing as patients with minor depression visit 59 physicians. The actors carried hidden recording devices to document the visit. 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 these visits would occur or what the case presentation would be.

Both male and female actors portrayed a 26-year-old data entry clerk with chronic headaches, weight gain, and sleep excess (10 hours nightly). The "patient", who was recently divorced and socially isolated, expressed sadness when discussing the divorce. He or she was neither overly animated nor flat in demeanor and volunteered no depressive symptoms unless asked.

"We chose this scenario because it represented a common presentation for depression in primary care: subtle mental health distress of a sufficient degree to be associated with dysfunction," said Carney.

A majority of the physicians -- 43 of the 59, or 73% -- recognized that "patients" were depressed, the researchers found. Their results appear in the December issue of the Journal of Family Practice.

The physicians who recognized depression asked twice as many questions on average about feelings compared with those who didn't recognize it. They also spent approximately twice as much time on what is known as an affective focus on their patient. That is, they spent more time reassuring patients, calling attention to, and accepting patient feelings, as well as disclosing their own feelings, Carney and colleagues found.
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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