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Cited by 121Mental Health Treatment and AccessPatient-Provider Communication in HealthcareAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Suffering in silence: reasons for not disclosing depression in primary care

Open access
Bell, R. A., Franks, P., Duberstein, P. R., Epstein, R. M., Feldman, M. D., Garcia, E. F. y., Kravitz, R. L.·2011·The Annals of Family Medicine
DOI 10.1370/afm.1277PMC PMC3185469
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Abstract

PURPOSE: Depression symptoms are underreported by patients. We thus assessed individuals' reasons for not disclosing depression to their primary care physician. METHODS: We conducted a follow-up telephone survey of 1,054 adults who had participated in the California Behavioral Risk Factor Survey System. Respondents were asked about reasons for nondisclosure of depressive symptoms to their primary care physician, depression-related beliefs, and demographic characteristics. Descriptive and inferential statistical procedures were used to characterize perceived obstacles to disclosure. RESULTS: Of the respondents, 43% reported 1 or more reasons for nondisclosure. The most frequent reason was the concern that the physician would recommend antidepressants (22.9%; 95% confidence interval, 18.8%-27.5%). Reported reasons for nondisclosure of depression varied based on whether the respondent had a history of depression. 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). 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). 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. CONCLUSIONS: Many adults subscribe to beliefs likely to inhibit explicit requests for help from their primary care physician during a depressive episode. Interventions should be developed to encourage patients to disclose their depression symptoms and physicians to ask about depression.

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  • Medical patients often do not spontaneously report distress, psychiatric symptoms, or functional impairment to their healthcare providers, and also may not recognize the negative impact that mental distress has on their health.

    “For example, medical patients often do not spontaneously report distress, psychiatric symptoms, or functional impairment to their healthcare providers, and also may not recognize the negative impact that mental distress has on their health [50].”

    From Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. (2017) · cites this paper as [50]

    The Discussion (page not available in our copy) says many patients will not report important symptoms spontaneously, and the study documents barriers to disclosing depression in primary care. It does not establish nondisclosure of functional impairment or that patients fail to recognize the negative impact of mental distress on their health. (LLM, conf=0.87)

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Research works printed but not linked: 1

  1. Groves RM, Fowler FJ, Couper MP, Lepkowski JM, Singer E, Tourangeau R. Survey Methodology. 2nd ed. Hoboken, NJ: Wiley; 2009.

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Authors
Bell, R. A., Franks, P., Duberstein, P. R., Epstein, R. M., Feldman, M. D., Garcia, E. F. Y., & Kravitz, R. L.
Affiliations
  • University of California, Davis (US)
  • University of Rochester (US)
  • University of California, San Francisco (US)
ORCID
Venue
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Published
2011-09-01
Volume
9
Issue
5
Pages
439-446
ISSN
  • 1544-1709 (ISSN-L)
  • 1544-1717
DOI
10.1370/afm.1277
PMC
PMC3185469
OpenAlex
W2165786334
Cited by
121
References
38
Citations by year
2026: 3 · 2025: 6 · 2024: 5 · 2023: 13 · 2022: 12 · 2021: 7 · 2020: 9 · 2019: 10 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 5 · 2014: 11 · 2013: 7 · 2012: 9
FWCI
12.18
Type
journal article
Language
en
Open access
Locations
  • The Annals of Family Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (R01MH079387)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, non-disclosure, barriers to disclosure, primary care, depression stigma, help-seeking, depressive symptoms, family history of depression, socioeconomic status, gender differences
MeSH terms
Adolescent, Adult, Antidepressive Agents, California, Depression, Educational Status, Female, Humans, Income, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Patient Acceptance of Health Care, Primary Health Care, Severity of Illness Index, Sex Factors, Disclosure, Young Adult

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