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Women's and doctors' accounts of their experiences of depression in primary care: the influence of social and moral reasoning on patients' and doctors' decisions

Community Health Sciences, General Practice Section, School of Clinical Sciences and Community Health, University of Edinburgh, 20 West Richmond Street, Edinburgh EH8 9DX, UK, Margaret.maxwell{at}ed.ac.uk

Background: Little is known about how general practitioners (GPs) manage depression within everyday clinical practice, particularly in relation to the issue of `problem definition'. In addition, there has been relatively little research on the patients' perspective of depression and its management in primary care.

Methods: Qualitative interviews explored women's and GPs' experiences of recognizing depression and their experiences of the management of depression. Thirty-seven women and 20 GPs were recruited from practices in four National Health Service Board areas of Scotland. Each participant was interviewed at the start of the study, and 30 women and 19 GPs were revisited approximately 9—12 months later so that the process of care could be reviewed.

Results: The findings demonstrate the social and moral reasoning that lies behind women's decisions to seek help and to subsequently accept their GPs' explanation and advice, and that the acceptance of antidepressants created a moral dilemma for the women. For GPs, the diagnosis and management of depression led to contemplating the boundaries of their professional role, and social and moral reasoning was also evident in their decision-making processes.

Discussion: The implication is that, for the majority of women, a chronic-disease model for the management for depression in primary care would be likely to increase rather than reduce the moral dilemma. In addition, the management of depression is not solely based on clinical decisions, so the applicability of a chronic-disease model to primary care requires further consideration.

Key Words: Chronic illness • Depression • Primary care • Qualitative research

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