Patient’s Reasons for Not Disclosing Depression

Article for Discussion

Bell RA, Franks P, Duberstein PR, et al. Suffering in silence: reasons for not disclosing depression in primary care. Ann Fam Med. 2011;9(5):439–446.

Discussion Tips

Depression can be challenging to detect, and it is easy to blame patients for framing their visits in ways that make detection more difficult. More challenging is to try to understand depression from the patients’ point of view and to consider the effects of our own behavior in creating an environment in which patients are comfortable sharing their deep concerns, even if those concerns challenge our medical model. This issue’s journal club article gives us data to inform our efforts to create an open environment for patients to share depressive symptoms.

Discussion Questions

• What questions are asked by this study and why does it matter? How was theory used to frame the questions?

• How does this study advance beyond previous research and clinical practice on this topic?

• How strong is the study design for answering the question?

• To what degree can the findings be accounted for by:

  1. How patients were selected, excluded, or lost to follow-up?

  2. How the main variables were measured?

  3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?

  4. Chance?

  5. How the findings were interpreted?

• How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?

• What are the main study findings?

• What reflections do you have on (1) the factors that patients say affect their disclosure of depressive symptoms, and (2) the characteristics of patients less likely to disclose depression? How might our/your approach to patients in general, and to the diagnosis and treatment of depression in particular, help create an environment in which patients feel safe disclosing depressive symptoms?

• How might this study change your practice? Policy? Education? Research?

• Could patients in your practice be engaged in interpreting or helping your practice to use the findings? How?

• What are the next steps in interpreting or applying the findings to change practice?

• What researchable questions remain?