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  Vol. 4 No. 5, May 1995 TABLE OF CONTENTS
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Depression in Rural Family Practice

Easy to Recognize, Difficult to Diagnose

Jeffrey L. Susman, MD; Benjamin F. Crabtree, PhD; Gregory Essink

Arch Fam Med. 1995;4(5):427-431.


Abstract

Objective
To explore rural family physicians' decisionmaking processes when they encounter depression.

Design
Exploratory qualitative "field study" using individual in-depth interviews and participant observation. Interviews were audiotaped, transcribed, and analyzed by an editing approach.

Setting
Rural Nebraska family physicians' offices.

Participants
A purposeful sample of six rural Nebraska family physicians, including five men and one woman, aged 35 to 65 years; two in solo practice, three in two-person practices, and one in a group practice; in communities with populations ranging from 600 to 6500.

Main Outcome Measures
Themes common to all interviews.

Results
Themes included the following: depression is easy to recognize but difficult to diagnose; depression is readily treatable but requires negotiation to manage; and depression is important but time and resources are limited. The inadequate diagnosis and treatment of depression appeared to be partly artifactual and must be understood against a background of perceived stigma, high prevalence of depressive symptoms, structural barriers to care, and context of rural practice.

Conclusions
Rural family physicians may have a more deliberate, organized, and rational approach to depressive disorders than previously reported. Depression is commonly recognized by rural family physicians; however, they hesitate to diagnose this condition because of diagnostic uncertainty, perceived stigma, the desire to preserve the physician-patient relationship, time and financial pressures, and a lack of supporting resources.



Author Affiliations

From the Department of Family Practice, University of Nebraska Medical Center, Omaha.



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