![]() ![]() 4 Suboptimal levels of recognition and treatment are due to a variety of physician, health system, and patient factors. 2, 3 Because patients are often treated in primary care, 3 efforts have been made to improve recognition, treatment, and follow-up for patients with depression in general practice. 1 In one-fourth of primary care patients with MDD, the condition is not diagnosed, 1 and a majority who seek help from a primary care physician do not receive appropriate treatment. ![]() Lifetime and 12-month prevalence of major depressive disorder (MDD) in the United States has been estimated to be 16.2% and 6.6%, respectively. Number of reported disclosure barriers was predicted by demographic characteristics (being female, Hispanic, of low socioeconomic status), depression beliefs (depression is stigmatizing and should be under one’s control), symptom severity, and absence of a family history of depression. Respondents with clinically significant depressive symptoms rated 10 of 11 barriers to disclosure as more personally applicable than did those without symptoms (all P values =.014). For example, respondents with no depression history were more likely to believe that depression falls outside the purview of primary care ( P=.040) and more likely to fret about being referred to a psychiatrist ( P=.036). ![]() Reported reasons for nondisclosure of depression varied based on whether the respondent had a history of depression. The most frequent reason was the concern that the physician would recommend antidepressants (22.9% 95% confidence interval, 18.8%–27.5%). Of the respondents, 43% reported 1 or more reasons for nondisclosure. Departments of Communication and Public Health Sciences, University of California, Davis, Davis, California (Bell) Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California (Bell, Franks, Fernandez y Garcia, Kravitz) Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, California (Franks) Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Duberstein) Rochester Center for the Improvement of Communication in Health Care, Departments of Family Medicine and Psychiatry, Division of Oncology and School of Nursing, University of Rochester Medical Center, Rochester, New York (Epstein) Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (Feldman) Department of Pediatrics, University of California, Davis, Sacramento, California (Fernandez y Garcia) Division of General Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, California (Kravitz) ![]()
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