Latvian family physicians' experience diagnosing depression in somatically presenting depression patients: A qualitative study.
BACKGROUND
Depression continues to be under-diagnosed in primary care settings. One factor that influences physicians' likelihood of diagnosing depression is patients' presentation style. Patients who initially present with somatic symptoms are diagnosed at a lower rate and with greater delay than patients who present with psychosocial complaints.


OBJECTIVE
To identify the barriers preventing depression diagnosis in somatically presenting patients in an Eastern European primary care setting.


METHODS
Thematic analysis of semi-structured interviews with 16 family physicians (FPs) in Latvia. FPs were sampled using a maximum variation strategy, varying on patient load, urban/rural setting, FP gender, presence/absence of on-site mental health specialists, and FP years of practice.


RESULTS
FPs observed that a large subgroup of depression patients presented with solely somatic complaints. FPs often did not recognize depression in somatically presenting patients until several consultations had passed without resolution of the somatic complaint. When FPs had psychosocial information about the somatically presenting patient, they recognized depression more quickly. Use of depression screening questionnaires was rare. Barriers to diagnosis continued beyond recognition. Faced with equivocal symptoms that undermined clinical certainty, FPs postponed investigating their clinical suspicion that the patient had depression and pursued physical examinations that delayed depression diagnosis. FPs also used negative physical examination results to convince reluctant patients of a depression diagnosis.


CONCLUSIONS
Delayed recognition, the need to rule out physical illness, and the use of negative physical examination results to discuss depression with patients all slowed the path to depression diagnosis for somatically presenting patients in Latvian primary care.
a Department of Communication Studies , Riga Stradiņš University , Riga , Latvia.
Maija S
MS
Leff
b Department of Psychiatry and Narcology , Riga Stradiņš University , Riga , Latvia.
Jeļena
J
Vrubļevska
a Department of Communication Studies , Riga Stradiņš University , Riga , Latvia.
Agita
A
Lūse
b Department of Psychiatry and Narcology , Riga Stradiņš University , Riga , Latvia.
Elmārs
E
Rancāns
D057210:Delayed Diagnosis; D003863:Depression / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007844:Latvia; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
Depression; diagnosis; general practice; qualitative methods; unexplained somatic complaints