Managing depression among ethnic communities: a qualitative study.
OBJECTIVE
Clinical care for depression in primary care negotiates a path between contrasting views of depression as a universal natural phenomenon and as a socially constructed category. This study explores the complexities of this work through a study of how family physicians experience working with different ethnic minority communities in recognizing, understanding, and caring for patients with depression.


METHODS
We undertook an analysis of in-depth interviews with 8 family physicians who had extensive experience in depression care in 3 refugee patient groups in metropolitan Victoria and Tasmania, Australia.


RESULTS
Although different cultural beliefs about depression were acknowledged, the physicians saw these beliefs as deeply rooted in the recent historical and social context of patients from these communities. Traumatic refugee experiences, dislocation, and isolation affected the whole of communities, as well as individuals. Physicians nevertheless often offered medication simply because of the impossibility of addressing structural issues. Interpreters were critical to the work of depression care, but their involvement highlighted that much of this clinical work lies beyond words.


CONCLUSIONS
The family physicians perceived working across cultural differences, working with biomedical and social models of depression, and working at both community and individual levels, not as a barrier to providing high-quality depression care, but rather as a central element of that care. Negotiating the phenomenon rather than diagnosing depression may be an important way that family physicians continue to work with multiple, contested views of emotional distress. Future observational research could more clearly characterize and measure the process of negotiation and explore its effect on outcomes.
Furler
John
J
Primary Care Research Unit, Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053. j.furler@unimelb.edu.au
Kokanovic
Renata
R
Dowrick
Christopher
C
Newton
Danielle
D
Gunn
Jane
J
May
Carl
C
D000328:Adult; D003156:Community Mental Health Services; D054521:Cultural Competency; D018864:Cultural Diversity; D003863:Depression / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology*; D005006:Ethnicity / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D054525:Minority Health; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D036301:Qualitative Research; D012036:Refugees / Q000523:psychology*; D013648:Tasmania; D014505:Urban Population; D014739:Victoria
Med Care. 2000 Mar;38(3):300-10
10718355
Soc Sci Med. 2006 Feb;62(3):721-30
16046038
Health Psychol. 1995 Dec;14(7):641-6
8654342
J Health Soc Behav. 2002 Sep;43(3):296-306
12467254
Fam Pract. 2007 Sep;24(4):358-64
17630269
Australas Psychiatry. 2006 Jun;14(2):212-5
16734653
Soc Sci Med. 2005 Apr;60(7):1625-35
15652693
Fam Pract. 2008 Dec;25(6):438-44
18836095
BMJ. 1995 Jul 1;311(6996):42-5
7613329
Patient Educ Couns. 2003 May;50(1):51-4
12767585
Ann Fam Med. 2005 Jan-Feb;3(1):3-6
15671184
Fam Pract. 2006 Feb;23(1):111-5
16246851
Cult Med Psychiatry. 1999 Sep;23(3):349-80; discussion 381-99
10572739
Ann Fam Med. 2006 Nov-Dec;4(6):527-33
17148631
BMJ. 1995 Nov 11;311(7015):1274-6
7496238
J Gen Intern Med. 2007 May;22(5):701-3
17370030
Community Ment Health J. 2003 Feb;39(1):33-46
12650554
Fam Pract. 2010 Aug;27(4):447-58
20378630
Sociol Health Illn. 2010 May;32(4):511-27
20412463
Ann Fam Med. 2005 Jan-Feb;3(1):31-7
15671188
J Gen Intern Med. 1999 Sep;14(9):569-80
10491249
Ann Fam Med. 2008 Jan-Feb;6(1):30-7
18195312
Patient Educ Couns. 2003 Oct;51(2):99-106
14572938
Ann Fam Med. 2006 Jul-Aug;4(4):302-9
16868233
BMJ. 1995 Jul 8;311(6997):109-12
7613363
Soc Sci Med. 2007 Aug;65(3):536-47
17470381
J Fam Pract. 2001 Oct;50(10):864-70
11674889