Patients' perspectives on the use of self-assessment depression rating scales in primary care.

Conference: 
Talk Code: 
4D.2
Presenter: 
Carl Wikberg
Co-authors: 
Agneta Pettersson , Jeanette Westman, Cecilia Björkelund, Eva-Lisa Petersson.
Author institutions: 
Department of Public Health and Community Medicine, Section of Primary Health Care, Institute of Medicine, University of Gothenburg, Sweden., Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden., Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden., Swedish Council on Health Technology Assessment (SBU), Stockholm

Problem

In Sweden as in many other countries mental health problems are increasing.Although depression is common, many general practitioners miss about 50% of all patients fulfilling the criteria’s for depression.General practitioners sometimes use self-assessment instruments, to screen or to help to diagnose. However, patient centered use of self-assessment scales have not been tested and evaluated within primary care. Studies covering the patients’ perceptions, which are important in structured use, are lacking. Literature shows that GPs’ perceptions are that a self-assessment scale does not add anything to the consultation and that it is more of a hindrance than a help to diagnosis and the consultation as a whole. We hypothesized that patients’ perceptions would be in line with GPs, and if so, the role of depression rating scales in primary care should be reconsidered.The aim of the current study was to explore how patients with depression perceive the use of the MADRS-S self-assessment scale for depression in primary care consultations with GPs.

Approach

We invited patients from an ongoing randomized clinical trial (RCT) in Sweden to partake in a focus group study. The RCT examined the effects of continuous use of the self-assessment scale Montgomery Asberg Depression Rating Scale-Self (MADRS-S) on newly diagnosed depressed patients within primary care. We conducted three focus group interviews.All interviews were recorded, and were then transcribed verbatim by an external source.We analyzed the data qualitatively, with systematic text condensation according to Malterud.

Findings

Three categories emerged from the analysis: I) Confirmation; MADRS-S shows that I have depression and how serious it is, II) Centeredness; the most important thing is for the GP to listen to and take me seriously and III) Clarification; MADRS-S helps me understand why I need treatment for depression.

Consequences

Use of self-assessment scales such as MADRS-S could find its place,but needs to adjust to the multifaceted environment that primary care provides. There is need for more information and education on how to practically use the instruments, both for GPs and patients. The result shows the diversity from what general practitioners’ perceive. When structurally using self-assessment scales in primary care knowledge about the patients perception of the use is advantageous

Submitted by: 
Carl Wikberg
Funding acknowledgement: 
Rehsam, Swedish Social Insurance Agency, RS11-013, and Region Västra Götaland. We would also like to thank the participating patients in this study although they remain anonymous.