title: A qualitative study of depression in primary care: missed opportunities for diagnosis and education.
abstract: OBJECTIVE
  Depression is one of the most commonly encountered chronic conditions in primary care, yet it remains substantially underdiagnosed and undertreated. We sought to gain a better understanding of barriers to diagnosis of and entering treatment for depression in primary care.
  
  
  METHODS
  We conducted and analyzed interviews with 15 subjects currently being treated for depression recruited from primary care clinics in an academic medical center and an academic public hospital. We asked about experiences with being diagnosed with depression and starting treatment, focusing on barriers to diagnosis, subject understanding of depression, and information issues related to treatment decisions.
  
  
  RESULTS
  Subjects reported many visits to primary care practitioners without the question of depression being raised. The majority had recurrent depression. Many reported that they did not receive enough information about depression and its treatment options. In the majority of cases, practitioners decided the course of treatment with little input from the patients.
  
  
  CONCLUSIONS
  In this sample of depressed patients, we found evidence of frequent missed diagnoses, substantial information gaps, and limited patient understanding and choice of treatment options. Quality improvement efforts should address not only screening and follow-up but patient education about depression and treatment options along with elicitation of treatment preferences.
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, WA, USA. Barry.Saver@umassmed.edu
authors.forename: Barry G
authors.initials: BG
authors.lastname: Saver
authors.forename: Victoria
authors.initials: V
authors.lastname: Van-Nguyen
authors.forename: Gina
authors.initials: G
authors.lastname: Keppel
authors.forename: Mark P
authors.initials: MP
authors.lastname: Doescher
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care; D014861:Washington