Variations in approaching the diagnosis of depression: A guided focus group study

BACKGROUND. Primary care physicians are often held to the same standard of performance as mental health specialists, yet they face special challenges in recognizing and treating depression. The purpose of this study was to explore the range of approaches to diagnose depression. METHODS. A purposeful sample of 21 primary care physicians in three US cities participated. A semistructured series of questions and clinical cases stimulated discussions about recognizing and managing major and minor depression. The focus groups were videotaped, and data were analyzed by two independent reviewers using the classic method of content analysis. RESULTS. Primary care providers have three major ways of approaching the diagnosis of depression: a biomedical exclusionary approach, where investigation of all physical complaints occurs first; a mental health approach, where psychosocial aspects of a presentation are pursued first; and a synergistic approach, where physical and mental health complaints are addressed simultaneously. Physicians move freely across all approaches depending on patient cues. CONCLUSIONS. Physicians' approaches to depression vary depending on patient characteristics and cues. Through a better understanding of current practices, future researchers can identify the optimal clinical approaches to match the characteristics and cues of specific patients. This study informed the development of a larger objective study of primary care physician performance.