Wittkampf K A, van Zwieten M, Smits F Th, Schene A H, Huyser J, van Weert H C
Department of Psychiatry, Programme for Mood Disorders, University of Amsterdam and Jellinenk Mentrum Mental Health Care, Amsterdam, The Netherlands.
Fam Pract. 2008 Dec;25(6):438-44. doi: 10.1093/fampra/cmn057. Epub 2008 Oct 3.
In general practice, depression is often not recognized. As treatment of depression is effective, screening has been proposed as one solution to combat this 'hidden morbidity'. The results of screening programmes for depression, however, are inconsistent and most studies do not show a positive effect on patient outcomes. Patients do not always accept this diagnosis and hence do not receive proper treatment. Nothing is known about the tendency of those patients who screen positive for depression to accept treatment for their 'disclosed' disorder.
In this study, we aimed to better understand the views of patients who screened positive in a screening programme for depression.
We performed a qualitative study with semi-structured in-depth interviews with 17 patients. These adult patients (nine females), all suffering from major depressive disorder, were disclosed by a screening programme for depression performed within 11 Dutch general practices. The transcripts were independently analysed by two researchers using MAXqda2.
All patients appreciated the active way in which they were approached for screening. Fifteen of the 17 patients recognized the depressive symptoms but nine of them did not accept the diagnosis. The first explanation for resistance to the diagnosis of depression is fear of stigmatization and scepticism about the usefulness of labelling. Secondly, patients experienced their depressive symptoms as a normal and transitory reaction to adversity. Thirdly, patients had doubts about the necessity and effectiveness of treatment. Depressive symptoms, such as feelings of guilt, self-depreciation and fatigue, hamper help-seeking behaviour.
We conclude that some patients with undisclosed depression, who took the trouble of going through a complete screening programme, felt aversion to being diagnosed as having depression. In the context of screening for depression, we recommend that the patients' view on depression be elicited before diagnosing and offering treatment.
在一般医疗实践中，抑郁症常常未被识别。由于抑郁症的治疗是有效的，因此有人提出进行筛查作为应对这种“隐性疾病”的一种解决方案。然而，抑郁症筛查项目的结果并不一致，大多数研究并未显示对患者预后有积极影响。患者并不总是接受这种诊断，因此无法获得恰当的治疗。对于那些抑郁症筛查呈阳性的患者接受针对其“已确诊”疾病治疗的倾向，我们一无所知。
在本研究中，我们旨在更好地了解在抑郁症筛查项目中呈阳性的患者的观点。
我们进行了一项定性研究，对17名患者进行了半结构化深入访谈。这些成年患者（9名女性）均患有重度抑郁症，是在荷兰11家普通诊所开展的抑郁症筛查项目中被筛查出来的。两位研究人员使用MAXqda2对访谈记录进行了独立分析。
所有患者都对他们被主动邀请参加筛查的方式表示赞赏。17名患者中有15名认识到了抑郁症状，但其中9人不接受诊断。对拒绝抑郁症诊断的第一种解释是害怕被污名化以及对贴标签的有用性持怀疑态度。其次，患者将他们的抑郁症状视为对逆境的正常和暂时反应。第三，患者对治疗的必要性和有效性存在疑虑。诸如内疚感、自我贬低和疲劳等抑郁症状会妨碍寻求帮助的行为。
我们得出结论，一些未被发现患有抑郁症的患者，尽管费心完成了完整的筛查项目，但仍反感被诊断为患有抑郁症。在抑郁症筛查的背景下，我们建议在诊断和提供治疗之前先了解患者对抑郁症的看法。
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