Recognition of depression in people of different cultures: a qualitative study.
BACKGROUND
Many minority group patients who attend primary health care are depressed. To identify a depressive state when GPs see patients from other cultures than their own can be difficult because of cultural and gender differences in expressions and problems of communication. The aim of this study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive features.


METHODS
The data were collected in focus groups and through individual interviews with GPs in northern Sweden and analysed by qualitative content analysis.


RESULTS
In the analysis three themes, based on various categories, emerged; "Realizing the background", "Struggling for clarity" and "Optimizing management". Patients' early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in the meetings were sometimes confused. GPs based their judgement mainly on clinical intuition and the established classification of depressive disorders was discussed. Tools for management and adequate action were diffuse.


CONCLUSIONS
Dialogue about patients' illness narratives and social context are crucial. There is a need for tools for multicultural, general practice care in the depressive spectrum. It is also essential to be aware of GPs' own conceptions in order to avoid stereotypes and not to under- or overestimate the occurrence of depressive symptoms.
Lehti
Arja
A
Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 85 Umeå, Sweden. arja.lehti@vll.se
Hammarström
Anne
A
Mattsson
Bengt
B
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003144:Communication Barriers; D003431:Cross-Cultural Comparison; D018864:Cultural Diversity; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis*; D005194:Family Practice / Q000193:education / Q000592:standards; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D008016:Life Change Events; D008297:Male; D008913:Minority Groups / Q000523:psychology; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education / Q000523:psychology* / Q000592:standards; D036301:Qualitative Research; D011787:Quality of Health Care; D012737:Sex Factors; D013548:Sweden