General practitioners' views about diagnosing and treating depression in Maori and non-Maori patients

Abstract

INTRODUCTION: The study investigated general practitioners’ (GPs’) views about recognising and treating depression among patients to establish possible reasons for reported lower levels of diagnosis and treatment of depression among Maori compared to non-Maori patients. METHODS: Semi-structured interviews with 23 GPs in the Auckland region, including both Maori and non-Maori GPs, elicited GPs’ views about risk factors for depression, recognising depression and circumstances in which GPs would prescribe medication or recommend other treatments for depression. FINDINGS: A framework was developed which incorporated the strategies GPs reported using to diagnose and treat depression. This consisted of three categories: (a) how depression is identified, (b) factors influencing treatment decisions, and (c) treatment outcomes. Reasons reported by GPs as most likely to lead to ethnic differences in diagnosing depression were greater stigma relating to admitting depression among Maori patients, Maori patients being less likely to talk about being depressed, and the need for patients to have effective communication with their GP. Effective communication, where Maori patients felt free to talk about personal feelings, was more likely when there was an established relationship between the GP and patient. CONCLUSION: The findings are consistent with previous reports that depression is less likely to be diagnosed by GPs among Maori patients, compared to non-Maori patients. GPs who are able to establish effective communication with patients, gain their trust and take account of the reluctance of some Maori patients to talk about personal feelings, are more likely to diagnose and treat depression effectively. KEYWORDS: Depression; diagnosis; treatment; primary care; Maori; ethnicity; New Zealand