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