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Open Access Highly Accessed Research article

Feeling labeled, judged, lectured, and rejected by family and friends over depression: Cautionary results for primary care clinicians from a multi-centered, qualitative study

Erik Fernandez y Garcia1*, Paul Duberstein23, Debora A Paterniti456, Camille S Cipri4, Richard L Kravitz45 and Ronald M Epstein237

Author Affiliations

1 Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, CA, USA

2 Center for Communication and Disparities Research and the Rochester Health Decision Making Group, University of Rochester Medical Center, Rochester, New York, USA

3 Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA

4 Center for Healthcare Policy and Research, University of California, Davis, School of Medicine, Sacramento, CA, USA

5 Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, CA, USA

6 Department of Sociology, University of California, Davis, Sacramento, CA, USA

7 Departments of Family Medicine and Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

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BMC Family Practice 2012, 13:64  doi:10.1186/1471-2296-13-64

Published: 29 June 2012

Abstract

Background

Family and friends may help patients seek out and engage in depression care. However, patients’ social networks can also undermine depression treatment and recovery. In an effort to improve depression care in primary care settings, we sought to identify, categorize, and alert primary care clinicians to depression-related messages that patients hear from friends and family that patients perceive as unhelpful or detrimental.

Methods

We conducted 15 focus groups in 3 cities. Participants (n = 116) with a personal history or knowledge of depression responded to open-ended questions about depression, including self-perceived barriers to care-seeking. Focus group conversations were audio-recorded and analyzed using iterative qualitative analysis.

Results

Four themes emerged related to negatively-received depression messages delivered by family and friends. Specifically, participants perceived these messages as making them feel labeled, judged, lectured to, and rejected by family and friends when discussing depression. Some participants also expressed their interpretation of their families’ motivations for delivering the messages and described how hearing these messages affected depression care.

Conclusions

The richness of our results reflects the complexity of communication within depression sufferers’ social networks around this stigmatized issue. To leverage patients’ social support networks effectively in depression care, primary care clinicians should be aware of both the potentially beneficial and detrimental aspects of social support. Specifically, clinicians should consider using open-ended queries into patients’ experiences with discussing depression with family and friends as an initial step in the process. An open-ended approach may avoid future emotional trauma or stigmatization and assist patients in overcoming self-imposed barriers to depression discussion, symptom disclosure, treatment adherence and follow-up care.

Keywords:
depression; disclosure; norms; patient-provider communication; social support; qualitative analysis