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Open Access Research article

A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

Margaret Maxwell1*, Fiona Harris1, Carina Hibberd2, Eddie Donaghy1, Rebekah Pratt3, Chris Williams4, Jill Morrison4, Jennifer Gibb5, Philip Watson2 and Chris Burton2

Author Affiliations

1 Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Iris Murdoch Building, Stirling, FK9 4LA, UK

2 Community Health Sciences, University of Edinburgh, Edinburgh, UK

3 Department of Family Medicine and Community Health, University of Minnesota, Minnesota, USA

4 University of Glasgow, Glasgow, UK

5 Robert Gordon University, Aberdeen, UK

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BMC Family Practice 2013, 14:46  doi:10.1186/1471-2296-14-46

Published: 4 April 2013

Abstract

Background

Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.

Methods

Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.

Results

We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.

Conclusion

The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.

Keywords:
Depression; Case finding; Screening; PHQ9; Diabetes; Coronary heart disease; Primary care