Pilars de Pilar Marieke, Abholz Heinz-Harald, Becker Nicole, Sielk Martin
Abteilung für Allgemeinmedizin, Heinrich Heine Universität, Universitätsklinikum Düsseldorf.
Psychiatr Prax. 2012 Mar;39(2):71-8. doi: 10.1055/s-0031-1276897. Epub 2011 Sep 27.
OBJECTIVES How GPs describe their patients who they did not identify as suffering from depression but who were classified as such by PHQ-9? What conclusions can be drawn with regard to how depression is dealt with and the illness model in use? METHOD GPs who took part in a screening study were asked in interviews to talk about some of their patients - not being informed that these were those not identified as depressive by them. This study comprises 21 narrative interviews from 18 GPs. Analysis by Framework method by Lewis and Ritchie. RESULTS The low identification rate of depression is not the result of failed recognition of "psychological problems" but of other factors centring on GPs' particular way of working and their concepts about mental illness: making a diagnosis only in a contextual way of interpreting symptoms; using the time passing as a help for diagnosing; emphasis on the impairment rather the diagnosis; considering the therapeutic consequences before making a diagnosis; a tolerance concerning "deviation" respectively wider view on "normality". CONCLUSION Understanding the different ways of conceptionalizing mental illness by psychiatrists and general practitioners is basic for their cooperation.
目标 全科医生如何描述那些他们未认定为患有抑郁症但被PHQ-9分类为患有抑郁症的患者？关于抑郁症的处理方式及所采用的疾病模型能得出什么结论？方法 参与一项筛查研究的全科医生在访谈中被要求谈论他们的一些患者——未告知他们这些患者是那些未被他们认定为患有抑郁症的患者。本研究包括来自18名全科医生的21次叙述性访谈。采用刘易斯和里奇的框架法进行分析。结果 抑郁症的低识别率并非未能识别“心理问题”的结果，而是以全科医生的特定工作方式及其对精神疾病的观念为中心的其他因素所致：仅在对症状进行情境性解释的方式下进行诊断；利用时间推移辅助诊断；强调损害而非诊断；在做出诊断前考虑治疗后果；对“偏差”的容忍度或对“正常”的更宽泛看法。结论 理解精神科医生和全科医生对精神疾病的不同概念化方式是他们合作的基础。
