Depression in rural family practice. Easy to recognize, difficult to diagnose

Arch Fam Med. 1995 May;4(5):427-31. doi: 10.1001/archfami.4.5.427.


Objective: To explore rural family physicians' decision-making processes when they encounter depression.

Design: Exploratory qualitative "field study" using individual in-depth interviews and participant observation. Interviews were audiotaped, transcribed, and analyzed by an editing approach.

Setting: Rural Nebraska family physicians' offices.

Participants: A purposeful sample of six rural Nebraska family physicians, including five men and one woman, aged 35 to 65 years; two in solo practice, three in two-person practices, and one in a group practice; in communities with populations ranging from 600 to 6500.

Main outcome measures: Themes common to all interviews.

Results: Themes included the following: depression is easy to recognize but difficult to diagnose; depression is readily treatable but requires negotiation to manage; and depression is important but time and resources are limited. The inadequate diagnosis and treatment of depression appeared to be partly artifactual and must be understood against a background of perceived stigma, high prevalence of depressive symptoms, structural barriers to care, and context of rural practice.

Conclusions: Rural family physicians may have a more deliberate, organized, and rational approach to depressive disorders than previously reported. Depression is commonly recognized by rural family physicians; however, they hesitate to diagnose this condition because of diagnostic uncertainty, perceived stigma, the desire to preserve the physician-patient relationship, time and financial pressures, and a lack of supporting resources.

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel*
  • Data Collection
  • Depression / diagnosis*
  • Depression / epidemiology
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology
  • Family Practice
  • Female
  • Humans
  • Male
  • Nebraska / epidemiology
  • Physicians, Family*
  • Rural Health