A Qualitative Study of Depression in Primary Care: Missed Opportunities for Diagnosis and Education

I never knew how to express it, and I had a shame in expressing it. I felt the shame in mentioning it to my family, even though my family had a whole depression issue. So if I couldn’t talk to my family, then how could I have talked about it to a doctor?

I was good at hiding it, until I just fell apart one day.

I had no indication that they were thinking about that while they were trying out other things. I presented myself with physical symptoms, and that was it.

I think that because the subject was about my pain, other matters at hand, that they didn’t ask about my sleeping habits, my mood, appetite. My doctor couldn’t have known.

I guess maybe I wasn’t really sure what was going on. And so, I probably didn’t mention it as problems I was having, and I perceived (my primary care doctor) as someone more interested in physical issues.

I had one person tell me it was all in my head, that there was nothing anyone could help.

When I mentioned it to my primary care doctor, he said, “Well, you smile—you don’t seem to be depressed.” So I just stopped mentioning it; that was about 2 years ago.

None. Not in the past either.

Quite frankly, [PCP told me] nothing. I just told them what I felt, and they identified it as depression. They didn’t go into the details, and I didn’t ask for the information.

I actually don’t remember too much. She said that it is nothing to get upset about, and that it is common and she will get help for it.

She [PCP] referred me to one of the patient libraries. So I went there and got some info on depression and taking medications and how that should help and what to do if it doesn’t.

I had one person tell me it was all in my head, there was nothing anyone could help. That’s why I went to [mental health clinic]. I knew they had counseling and medication.

I was given some brochures, but they seem like they’re written for sixth graders.

I was seeing a psychiatrist; they explained about my depression and why I got it.

I was given some literature to read and I had discussions with my counselor about it … No more information except research on my own.

They [mental health services agency] gave me some flyers that I read. They asked me which category fit me best.

The second doctor was very good at gauging my personality, figuring out the best way to talk to me.

I got a lot of information from the psychiatrist I saw.

I remember going to bookstores and reading.

My ears would pick up on things if I heard a show on TV, radio, a new article in a magazine

I went on the Internet, Web MD, looking for what the symptoms were, what I should be looking for, if it was triggered from a traumatic experience.

Just recently heard about synapses, serotonin, what they do. I guess maybe on the Internet I learned it was hereditary, so I can blame my mom and dad… . I think the more I learn about it, the more I understand it and can deal with it instead of just shutting down and assuming I’ll always be depressed. I like learning the scientific reasons for it.

I’ve seen that ad on TV—the little bouncing head, talking about things not getting from one synapse to another; I do understand there’s an organic element there. That’s nice to know, otherwise I could just blame myself. I learned more from watching that commercial on television [than from my provider].

As far as information about medicine and whatnot, I’d heard of Prozac, Paxil; I really do my research by asking people I know… . Media is a very powerful tool. All those commercials I used to make fun of, I understand now—the [drug name] commercials, …

It [getting information from provider] would have been very helpful. I could have looked by myself or gone to the library. But when you are depressed, you just want things handed to you.

They didn’t go into the details, and I didn’t ask for the information. I don’t want to blame them for not telling me more, because I didn’t invite or encourage them to share.

I was seeing a psychiatrist, they explained about my depression and why I got it. I wasn’t focusing on that much. I was thinking about a better way to kill myself.

I was afraid of counseling because I felt that my family would disown me. I ended up taking medication and I was afraid of dealing with people about this.

I guess shame, embarrassment. The Internet is better—I can just do it on my own.

Not wanting to just accept that that was going on. You have to get a job, move on, maintain some kind of normality.

She said, “When you’re ready, I’ve got a whole bunch of stuff you might want to read, you might find yourself in some of it.” She’d start slowly with the uncomfortable stuff. I just wasn’t ready to hear it.

I would have liked to know how medication or counseling, both would work for me. But the doc was like she was doctor and she would know better… . They are not able to show full concern because they are low in staff and funding. The frustration shows because you have to make it clear that you need more than this. For a patient who did not know how to make it clear, you are in a Catch-22.

The first counselor referred me to some pamphlets, kind of brushed over the whole subject. He seemed like he had reached a level of detachment with his job. Just totally unmemorable.

I did try to talk to doctors about depression. It just wasn’t working. I let my doctors know that. That doctor kept trying to tell me this was the best thing for me; I know there are other medications.

I would never sit down and read something about medicine. It has never interested me. I learned more from watching that commercial on television.

I don’t seek out information, but if I come across it, then I will take it and read it.