title: Relational barriers to depression help-seeking in primary care.
abstract: OBJECTIVE
  To identify attitudinal and interpersonal barriers to depression care-seeking and disclosure in primary care and in so doing, evaluate the primary care paradigm for depression care in the United States.
  
  
  METHODS
  Fifteen qualitative focus group interviews in three cities. Study participants were English-speaking men and women aged 25-64 with first-hand knowledge of depression. Transcripts were analyzed iteratively for recurring themes.
  
  
  RESULTS
  Participants expressed reservations about the ability of primary care physicians (PCPs) to meet their mental health needs. Specific barriers included problems with PCP competence and openness as well as patient-physician trust. While many reflected positively on their primary care experiences, some doubted PCPs' knowledge of mental health disorders and believed mental health concerns fell outside the bounds of primary care. Low-income participants in particular shared stories about the essentiality, and ultimate fragility, of patient-PCP trust.
  
  
  CONCLUSIONS
  Patients with depression may be deterred from care-seeking or disclosure by relational barriers including perceptions of PCPs' mental health-related capabilities and interests.
  
  
  CONCLUSIONS
  PCPs should continue to develop their depression management skills while supporting vigorous efforts to inform the public that primary care is a safe and appropriate venue for treatment of common mental health conditions.
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA. rlkravitz@ucdavis.edu
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.forename: Debora A
authors.initials: DA
authors.lastname: Paterniti
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Epstein
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Rochlen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bell
authors.forename: Camille
authors.initials: C
authors.lastname: Cipri
authors.forename: Erik
authors.initials: E
authors.lastname: Fernandez y Garcia
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Feldman
authors.forename: Paul
authors.initials: P
authors.lastname: Duberstein
mesh_terms: D002983:Clinical Competence; D003863:Depression / Q000188:drug therapy / Q000523:psychology*; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008603:Mental Health; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011594:Psychometrics; D036301:Qualitative Research; D012938:Social Perception; D035502:Trust