Depressed Patients Falling Through the Cracks in Primary Care


More than 8 million doctor’s appointments with primary care physicians are made due to depression each year. Primary care doctors are often the first point of contact; patients know and trust their family physicians because they have often known them for many years. This is why it is particularly disheartening that a significant portion of these 8 million doctor’s appointments end in a lack of treatment for depressed individuals.

A recent study published in the Journal of the American Medical Association shows that doctors aren’t doing much to improve their patients’ symptoms, and that the evaluations used to screen for mental health problems aren’t always accurate. Furthermore, the vast majority of people who go to primary care physicians for help remain undiagnosed. This can cause major problems in the future, because if the depression is left unchecked for long enough, it can lead to suicide or serious self harm.

A typical patient who goes into a doctor’s office for depression typically fills out a simple questionnaire and then discusses it with their physician. In the study done by the American Medical Association, this questionnaire was shown to be only somewhat effective in identifying depressed patients. This screening method attempts to quantify feelings into numbers on a scale, which can often be very subjective from patient to patient. Because of this, oftentimes  people who are screened for depression remain wrongfully undiagnosed.

These inaccurate misdiagnoses only add to patients’ distress. For depressed individuals, going out and seeking treatment is often quite a difficult step to take due to societal perceptions of the disease. In an article ran by the New York Times, Steven Petrow recounts his personal encounters with stigma. He states that he once dated someone who dumped him after finding out he took the antidepressant Lexapro. Additionally, Petrow’s own family told him to just “get over it”, because it was definitely “all in his head.” Furthermore, having a medication history that involved antidepressants prevented Petrow from obtaining health insurance under the Affordable Care Act because he was viewed as “too much of a risk” by insurance companies. When depressed people seek help despite all of these factors,  it is highly discouraging when they are told by their primary care physicians that nothing is wrong with them. Invalidating a depressed person’s mental illness only makes them feel worse about their own situation.

Patients that do receive treatment from their family doctor do not fare much better. Among primary care, depression is generally not treated as a chronic illness. Doctors often do not follow up with patients about medication dosage or other treatment methods. This is particularly troubling when faced with information from a recent study done by Dr. Tara Bishop at Cornell Medical College. Dr. Bishop and her team demonstrated that treating depression with a methodology similar to that used for diabetes or other chronic diseases was more effective than current treatment methods. Despite this, primary care continues to treat depression as as a disease with a one-time fix, with doctors prescribing antidepressants and never following up with their patients.

Although government officials are slowly starting to realize the importance of treating mental health issues with the same urgency and importance as physical illnesses, we clearly still have quite a long way to go with regards to making mental health care more accessible and less stigmatized. Integrating good, effective mental health treatment into primary care would be an extremely valuable resource for people without access to a good psychiatrist or reliable health insurance. However, as it stands right now, patients are falling through the cracks of the system, and it’s only a matter of time before something has to give.

 

References

Gilchrist, G., & Gunn, J. (2007). Observational studies of depression in primary care: what do we know? BMC Fam Pract8(1). doi:10.1186/1471-2296-8-28

Kravitz, R. L. (2013). Patient Engagement Programs for Recognition and Initial Treatment of Depression in Primary Care. JAMA310(17), 1818. doi:10.1001/jama.2013.280038

PBS. (2016, March). For depression, primary care doctors could be a barrier to treatment | PBS NewsHour. Retrieved from http://www.pbs.org/newshour/rundown/for-depression-primary-care-doctors-could-be-a-barrier-to-treatment/

Petrow, S. (2016, February 8). Opening Up About Depression. The New York Times.

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