Most patients who don’t disclose their feelings of depression to their primary care providers (PCPs) are primarily afraid they will be prescribed antidepressant medication, according to survey results published this month in the Annals of Family Medicine.

Depression goes undiagnosed in one-fourth of primary care patients with major depressive disorder, or MDD, and the majority of those who seek help from a PCP do not receive appropriate treatment. In a follow-up telephone survey of more than 1,000 adults, researchers from the University of California asked patients why they would not discuss depressive symptoms with their PCP. Overall, the following reasons were given:

23% had an aversion to antidepressant medication.

16% felt that a PCP was an inappropriate source of care for emotional problems.

15% were afraid medical records would be seen by others, such as an employer.

13% didn’t want to be sent to a counselor or psychiatrist.

12% didn’t want to be considered a psychiatric patient.

9% were uncomfortable sharing private information with their doctor.

8% felt they might lose emotional control.

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6% were uncertain about how to raise the topic.

5% concerned they would distract doctor from other health problems.

4% thought the doctor might think less of them; loss of esteem.

According to the findings, patients who exhibited moderate or severe depressive symptoms were more likely to subscribe to those reasons. Medication aversion (28%), sharing of medical records (26%), losing emotional control (21%), and being referred to as a psychiatric patient (20%) were the highest among those patients.

The investigators noted that depressed individuals may perceive their circumstances and competencies in a more negative light. Additionally, because the primary reason for nondisclosure was medication aversion, it may suggest patients’ lack of confidence in their ability to negotiate an acceptable plan of care that reflects their treatment preferences.

Physician’s Weekly wants to know…

Do you find that your patients are hesitant to discuss their emotional problems?

In what ways can physicians create an environment of trust for their patients?