The first consultation with a depressed patient: A qualitative study of GPs’ approaches to diagnosis
Open accessAbstract
Background: The first consultation with a depressed patient is important because many patients do not return for subsequent visits. Therefore, the first consultation provides a unique opportunity for diagnosis (if required) and treatment, but there are risks of both under and over-diagnosis. Aim: To understand how general practitioners utilize diagnosis when patients present with a new episode of depression. Method: We approached a random selection of twenty-one general practitioners (GPs) in Auckland, New Zealand and asked them to participate in a semi-structured telephone interview. The interviews explored “the first consultation for a depressed/distressed patient” were undertaken to theme saturation. Interviews were hand-written and later transcribed. Results: We identified three major themes in GPs’ approach to diagnosis. The issue of diagnosis was underpinned by a complex understanding of depression and the GP role. GPs did not always make a formal diagnosis, but the experience of a patient’s distress/depression was understood by drawing on a range of factors and resources. These included time, screening tools, clinician experience, and patient affect. GPs were careful about how they communicated a diagnosis, both in their documentation and in their conversations with patients. Conclusion: At an initial appointment, the distressed/depressed patient can present to their GP with various symptoms and differing degrees of distress. GPs draw upon a variety of skills and resources to negotiate these complexities. The value of a diagnosis was questioned and issues such as impairment may be more useful concepts for GPs. This is the first study to report the findings of the first visit.
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Limited consultation times restrict clinicians from conducting thorough evaluations, such as more advanced assessments and interactions with patients, and often lead to poor decision making.
“Limited consultation times restrict clinicians from conducting thorough evaluations, such as more advanced assessments and interactions with patients, and often lead to poor decision making [282].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [282]
In Results > Understanding depression (page not provided), some GPs said a 15-minute consultation was too short to make a diagnosis, and some said screening tools consumed limited time and impaired rapport. This supports the concern about time constraining assessment and patient interaction, but the paper does not say that short consultations often lead to poor decision-making or specifically prevent advanced assessments. (LLM, conf=0.86)
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Cites
A General Inductive Approach for Analyzing Qualitative Evaluation Data
Thomas, D. R. (2006) · American Journal of Evaluation · doi:10.1177/1098214005283748 · Cited by 10,858 · cited 2× · see citing works
“While there are some legitimate criticisms of distress inventories, there is also evidence that they are helpful from the patients’ perspective and can be used to build rapport,[8] and help doctors assess severity over time.”
BackgroundMethodAn international study of the relation between somatic symptoms and depression
Simon, G. E., VonKorff, M., Piccinelli, M., Fullerton, C., & Ormel, J. (1999) · New England Journal of Medicine · doi:10.1056/nejm199910283411801 · Cited by 1,303 · cited 2× · see citing works
“Estimates suggest that 11% of depressed patients do not report any psychological symptoms, and 45%–95% describe physical symptoms.[4] Depression is a co‐morbid condition of disorders but the diagnosis is often missed.”
BackgroundClinical diagnosis of depression in primary care: a meta-analysis
Mitchell, A. J., Vaze, A., & Rao, S. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60879-5 · Cited by 1,251 · cited 1× · see citing works
“[1,2] At the same time, false positives are not uncommon, with some patients being diagnosed with depression while not meeting the diagnostic criteria.[3] In this paper, we use the term distress for what the patient presents with and depression as an output of the consultation.”
MethodAnnual Research Review: The transdiagnostic revolution in neurodevelopmental disorders
Astle, D. E., Holmes, J., Kievit, R., & Gathercole, S. E. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13481 · Cited by 384 · cited 1× · see citing works
“[12] There is also a move internationally to use less pejorative terms such as “stuck” for common mental disorders such as depression and anxiety although we did not explore that issue in this study.[13,14]”
BackgroundDowrick, C., Leydon, G. M., McBride, A., Howe, A., Burgess, H., Clarke, P., Maisey, S., & Kendrick, T. (2009) · BMJ · doi:10.1136/bmj.b663 · Cited by 213 · see citing works
Self-citationWilliams, R., Jenkins, D. A., Ashcroft, D., Brown, B., Campbell, S., Carr, M., Cheraghi-Sohi, S., Kapur, N., Thomas, O., Webb, R., et al. (2020) · Lancet Public Health · doi:10.1016/s2468-2667(20)30201-2 · Cited by 206 · cited 2× · see citing works
“8% of their patients who have a major depressive disorder.[1,2] At the same time, false positives are not uncommon, with some patients being diagnosed with depression while not meeting the diagnostic criteria.”
BackgroundResultDowrick, C., & Frances, A. (2013) · BMJ · doi:10.1136/bmj.f7140 · Cited by 167 · cited 2× · see citing works
“”[6] For GPs, who are likely to see a more diverse and less uniformly unwell population, these issues are more pronounced.[6]”
BackgroundSelf-citationDepression Prevalence in Neuropathic Pain and Its Impact on the Quality of Life
Cherif, F., Zouari, H. G., Cherif, W., Hadded, M., Cheour, M., & Damak, R. (2020) · Pain Research and Management · doi:10.1155/2020/7408508 · Cited by 124 · cited 1× · see citing works
“[4] Depression is a co‐morbid condition of disorders but the diagnosis is often missed.[5] Navigation of the mind‐body interface requires skilful conversations to elucidate symptoms while minimizing stigma and maintaining the doctor‐patient relationship, a skill we feel is vital for all primary care clinicians.”
BackgroundReforming disease definitions: a new primary care led, people-centred approach
Moynihan, R., Brodersen, J., Heath, I., Johansson, M., Kuehlein, T., Minué-Lorenzo, S., Pétursson, H., Pizzanelli, M., Reventlow, S., Sigurdsson, J. A., et al. (2019) · BMJ evidence-based medicine · doi:10.1136/bmjebm-2018-111148 · Cited by 46 · cited 4×
“Moynihan et al 2019.”
BackgroundInfluentialDo PROMS improve outcomes in patients with depression in primary care?
Kendrick, T., & Maund, E. (2020) · British medical journal · doi:10.1136/bmj.m3313 · Cited by 15 · see citing works
An evidence-based first consultation for depression: nine key messages.
Arroll, B., Weng, Y., Moir, F., & Dowrick, C. (2018) · The British journal of general practice : the journal of the Royal College of General Practitioners · doi:10.3399/bjgp18x695681 · Cited by 6 · cited 1× · see citing works
“Two practicing GPs (BA and VM) drafted the questions to resolve questions in earlier research.[7] A mix of closed and open‐ended questions was used, with participants able to elaborate on key points at the interviewer’s discretion.”
MethodSelf-citation
Flagged first, then by citations
4 of the 15 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [1]Bushnell J MaGPIe Research Group Frequency of consultations and general practitioner recognition of psychological symptoms Br J Gen Pract 2004 53 838 42 PMC1324917 15719527
Cited by
Sorted by citations
Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
Yen, C., Epling, J. W., Rockwell, M., & Vaughn-Cooke, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020347 · Cited by 6 · see citing works
“Limited consultation times restrict clinicians from conducting thorough evaluations, such as more advanced assessments and interactions with patients, and often lead to poor decision making [282].”
The difficult inpatient, prevalence and characteristics.
Jackson, J. L., Murphy, M. G., & Fletcher, K. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.108785 · Cited by 6 · see citing works
Menear, M., Ashcroft, R., Dahrouge, S., Silveira, J., Booton, J., Emode, M., & McKenzie, K. (2024) · BMC Primary Care · doi:10.1186/s12875-024-02519-w · Cited by 2 · see citing works
“…qualitative studies on the quality of care for mental disorders in primary care have instead focused on the technical aspects of managing these conditions (e.g., diagnosing, treating) [29–32] or have examined experiences of care broadly without a specific focus on patient-centeredness [26, 33–36].”
Background
- Authors
- Arroll, B., Roskvist, R., Moir, F., Walsh, E., Louis, D., Buttrick, L., Khalil, N., Mount, V., & Dowrick, C.
- Affiliations
- University of Auckland (NZ)
- University of Bristol (GB)
- University of Liverpool (GB)
- Corresponding author
- Arroll, Bruce
- Venue
- Journal of Family Medicine and Primary Care
- Published
- 2022-07
- Volume
- 11
- Issue
- 7
- Pages
- 3934-3942
- ISSN
- 2249-4863 (ISSN-L)
- PMC
- PMC9648253
- OpenAlex
- W4289209726
- Cited by
- 5
- References
- 15
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Journal of Family Medicine and Primary Care (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by-nc-sa)
- Funders
- Oakley Mental Health Research Foundation
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- depression, initial consultation, general practitioners, diagnostic decision-making, underdiagnosis, overdiagnosis, patient distress, screening tool, clinician experience, communication of diagnosis, primary care, impaired functioning
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