Research ArticleOriginal Research

Unwritten Rules of Talking to Doctors About Depression: Integrating Qualitative and Quantitative Methods

Marsha N. Wittink, Frances K. Barg and Joseph J. Gallo
The Annals of Family Medicine July 2006, 4 (4) 302-309; DOI: https://doi.org/10.1370/afm.558

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Tables

  • Table 1.

    Semistructured Interview Guide Questions

    Have you discussed your feelings with your doctor?
        If YES, ask A and B
        If NO, skip to C and D
    A. Who brought it up? How do you think the discussion went? Do you think (he/she) would have known if you hadn’t brought it up?
    B. What does (he/she) say about it?
    C. What do you think your doctor thinks about the way you feel emotionally?
    D. What words (other than depression) would your doctor use to describe how you feel?
  • Table 2.

    Characteristics of Patients Who Identified Themselves as Depressed in Semistructured Interviews (n = 48)

    CharacteristicsPhysician Rated Patient Depressed n = 27Physician Rated Patient Not Depressed n = 21P Value
    Note: Data From the Spectrum Study (2001–2004).
    * Column percent.
    CES-D = Center for Epidemiologic Studies Depression Scale; BAI = Beck Anxiety Inventory; BHS = Beck Hopelessness Scale; MMSE = Mini-Mental State Examination.
    Sociodemographic characteristics
        Age, mean, No. (SD)73.0 (5.3)77.1 (5.3).012
        Women, No. (%)*21 (79)15 (71).623
        African American, No. (%)*10 (39)12 (57).173
        Education less than high school, No. (%)*8 (30)10 (48).210
    Psychological status
        CES-D score, mean (SD)18.3 (13.5)15.6 (10.0).450
        BAI score, mean (SD)10.0 (9.2)11.8 (8.5).498
        BHS score, mean (SD)5.5 (4.1)4.8 (3.7).607
    Cognitive status
        MMSE score, mean (SD)27.8 (2.2)27.1 (3.0).371
    Physician ratings at index visit
        Physician rates the patient as depressed, No. (%)*27 (100)0 (0).842
        Physician knows the patient very well, No. (%)*20 (75)15 (71).843
  • Table 3.

    Characteristics of Persons According to Themes Raised in Semistructured Interviews (n = 48)

    Characteristics“My doctor just picked it up” n = 6“I’m a good patient” n = 8“They just check out your heart and things” n = 7“They’ll just send you to a psychiatrist” n = 6
    Note: Data From the Spectrum Study (2001–2004).
    * Column percents.
    BAI = Beck Anxiety Inventory; CES-D = Center for Epidemiologic Studies Depression Scale; MMSE = Mini-Mental State Examination.
    Sociodemographic characteristics
        Age, mean y (SD)73.3 (3.3)77.5 (4.2)75.1 (7.8)71.3 (6.3)
        Women, No. (%)*6 (100)6 (75)4 (57)4 (67)
        African American, No. (%)*2 (33)3 (38)2 (28)3 (50)
        Education less than high school, No. (%)*2 (33)3 (38)2 (28)2 (33)
    Psychological status
        CES-D score, mean (SD)19.0 (11.8)11.9 (7.4)15.3 (9.6)14.0 (10.3)
        BAI score, mean (SD)10.5 (4.9)10.0 (9.1)6.4 (4.5)6.8 (3.8)
        BHS score, mean (SD)4.8 (4.9)3.8 (3.1)4.6 (3.7)5.7 (3.1)
    Cognitive status
        MMSE score, mean (SD)28.7 (1.2)27.5 (2.2)28.9 (0.7)27.8 (1.7)
    Physical health
        Physical function score, mean (SD)64.2 (21.5)63.6 (31.0)71.3 (24.8)56.7 (28.2)
        Role physical score, mean (SD)45.8 (36.8)65.6 (35.2)46.4 (44.3)29.2 (29.2)
        Role emotional score, mean (SD)88.9 (27.2)72.3 (39.8)50.0 (50.0)83.3 (40.8)
        Social function score, mean (SD)75.0 (17.7)70.3 (34.0)62.5 (27.0)72.9 (21.5)
        Bodily pain score, mean (SD)61.3 (17.7)55.0 (25.8)50.4 (26.1)43.8 (24.2)
        General health perception score, mean (SD)41.7 (15.7)61.3 (17.5)54.3 (16.4)42.5 (14.4)
        No. of medical conditions, mean (SD)8.7 (0.8)6.6 (2.9)8.0 (3.1)8.0 (2.3)
        No. of visits within 6 months, mean (SD)2.5 (1.0)2.8 (1.4)2.6 (1.5)2.8 (1.5)
    Discussion of depression with physician
        Doctor understood how you feel, No. (%)*5 (83)4 (50)1 (14)3 (50)
        Has discussed feelings with doctor, No. (%)*5 (83)3 (38)1 (14)2 (33)
    Physician ratings at index visit
        Physician rates the patient as depressed, No. (%)*6 (100)3 (38)4 (57)6 (100)
        Physician knows the patient very well, No. (%)*5 (83)6 (75)4 (57)4 (67)

Additional Files

  • Supplemental Appendix

    Supplemental Appendix. Spectrum Study Purposes and Assessment, Analytic, and Sampling Strategies.

    Files in this Data Supplement:

  • The Article in Brief

    Unwritten Rules of Talking to Doctors About Depression: Integrating Qualitative and Quantitative Methods

    Marsha N. Wittink MD, MBE, and colleagues

    Background Communication between patients and doctors can influence patients� health and their willingness to follow treatment recommendations. In this study, the authors set out to understand how older adult patients with depression view their relationship with their primary care doctor and whether that relationship influences the ways they communicate about depression.

    What This Study Found Participants� views of interactions with their doctors included the following themes: (1) �My doctor just picked it up.� Some patients feel that their doctor can �pick up on� aspects of their mood without needing to elicit them directly from the patient. (2) �I�m a good patient.� These patients feel that the doctor doesn�t view them as depressed, perhaps because they think of depression as a moral failing or because they want to avoid complaining or burdening the doctor. (3) �They just check out your heart and things.� In this case, patients do not bring up emotional issues because they may believe their doctor will not be interested. (4) �They�ll just send you to a psychiatrist.� Patients who expressed this opinion feel that the doctor would send them to a mental health specialist, rather than directly addressing any emotional issues.

    Implications

    • Patients� expectations and experiences with depression may have an impact on what they are willing to tell the doctor.
    • The give-and-take between patients and doctors is dynamic, a �dance� of sorts that influences doctors� ability to recognize depression and negotiate a treatment plan.
    • Doctors may, knowingly or unknowingly, signal to patients how they will address emotional problems. This influences how patients perceive their interactions with doctors about emotional problems.
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