title: A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK.
abstract: BACKGROUND
  Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.
  
  
  METHODS
  Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.
  
  
  RESULTS
  We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.
  
  
  CONCLUSIONS
  The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK. margaret.maxwell@stir.ac.uk
authors.forename: Margaret
authors.initials: M
authors.lastname: Maxwell
authors.forename: Fiona
authors.initials: F
authors.lastname: Harris
authors.forename: Carina
authors.initials: C
authors.lastname: Hibberd
authors.forename: Eddie
authors.initials: E
authors.lastname: Donaghy
authors.forename: Rebekah
authors.initials: R
authors.lastname: Pratt
authors.forename: Chris
authors.initials: C
authors.lastname: Williams
authors.forename: Jill
authors.initials: J
authors.lastname: Morrison
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gibb
authors.forename: Philip
authors.initials: P
authors.lastname: Watson
authors.forename: Chris
authors.initials: C
authors.lastname: Burton
mesh_terms: D016000:Cluster Analysis; D003159:Community-Institutional Relations; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D003376:Counseling; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy; D017144:Focus Groups; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D015588:Observer Variation; D010043:Outcome and Process Assessment, Health Care; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012606:Scotland; D011795:Surveys and Questionnaires; D000078329:Workforce
references.citation: Psychol Med. 2013 Mar;43(3):529-37
references.pmid: 22804849
references.citation: JAMA. 2008 Nov 26;300(20):2379-88
references.pmid: 19033588
references.citation: Psychosom Med. 2004 Nov-Dec;66(6):802-13
references.pmid: 15564343
references.citation: Br J Gen Pract. 2011 May;61(586):e279-89
references.pmid: 21619752
references.citation: Health (London). 2007 Apr;11(2):163-80
references.pmid: 17344270
references.citation: JAMA. 2008 Nov 12;300(18):2161-71
references.pmid: 19001627
references.citation: Diabetes Care. 2001 Jun;24(6):1069-78
references.pmid: 11375373
references.citation: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references.pmid: 6880820
references.citation: Implement Sci. 2010 Aug 06;5:62
references.pmid: 20687962
references.citation: Nat Rev Endocrinol. 2009 Dec;5(12):665-71
references.pmid: 19884900
references.citation: BMJ. 2008 Dec 19;337:a3017
references.pmid: 19098062
references.citation: Am J Manag Care. 2008 Aug;14(8):497-504
references.pmid: 18690765
references.citation: Br J Gen Pract. 2007 Jun;57(539):449-54
references.pmid: 17550669
references.citation: J Gen Intern Med. 1997 Jul;12(7):439-45
references.pmid: 9229283
references.citation: Diabet Med. 2006 Nov;23(11):1165-73
references.pmid: 17054590
references.citation: J Gen Intern Med. 2001 Sep;16(9):606-13
references.pmid: 11556941
references.citation: Med Care. 2003 Nov;41(11):1284-92
references.pmid: 14583691
references.citation: BMC Fam Pract. 2011 Mar 22;12:10
references.pmid: 21426542
references.citation: BMJ. 2009 Mar 19;338:b663
references.pmid: 19299474
references.citation: Ann Intern Med. 1998 Oct 15;129(8):613-21
references.pmid: 9786808
references.citation: CMAJ. 2012 Mar 6;184(4):413-8
references.pmid: 21930744
references.citation: BMJ. 2003 Nov 15;327(7424):1144-6
references.pmid: 14615341
references.citation: BMC Med. 2010 Oct 20;8:63
references.pmid: 20961442
references.citation: Br J Gen Pract. 2011 Feb;61(583):117-23
references.pmid: 21276338
references.citation: N Engl J Med. 2010 Dec 30;363(27):2611-20
references.pmid: 21190455
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002792
references.pmid: 16235301
references.citation: Circulation. 2008 Oct 21;118(17):1768-75
references.pmid: 18824640