Depression in rural family practice. Easy to recognize, difficult to diagnose.
OBJECTIVE
To explore rural family physicians' decision-making processes when they encounter depression.


METHODS
Exploratory qualitative "field study" using individual in-depth interviews and participant observation. Interviews were audiotaped, transcribed, and analyzed by an editing approach.


METHODS
Rural Nebraska family physicians' offices.


METHODS
A purposeful sample of six rural Nebraska family physicians, including five men and one woman, aged 35 to 65 years; two in solo practice, three in two-person practices, and one in a group practice; in communities with populations ranging from 600 to 6500.


METHODS
Themes common to all interviews.


RESULTS
Themes included the following: depression is easy to recognize but difficult to diagnose; depression is readily treatable but requires negotiation to manage; and depression is important but time and resources are limited. The inadequate diagnosis and treatment of depression appeared to be partly artifactual and must be understood against a background of perceived stigma, high prevalence of depressive symptoms, structural barriers to care, and context of rural practice.


CONCLUSIONS
Rural family physicians may have a more deliberate, organized, and rational approach to depressive disorders than previously reported. Depression is commonly recognized by rural family physicians; however, they hesitate to diagnose this condition because of diagnostic uncertainty, perceived stigma, the desire to preserve the physician-patient relationship, time and financial pressures, and a lack of supporting resources.
Susman
J L
JL
Department of Family Practice, University of Nebraska Medical Center, Omaha, USA.
Crabtree
B F
BF
Essink
G
G
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003625:Data Collection; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D009329:Nebraska / Q000453:epidemiology; D010821:Physicians, Family; D012423:Rural Health