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	Institution: CLOCKSS  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 4 No. 5, May 1995   Archives  •  Online Features Original Contributions  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal Depression in Rural Family Practice Easy to Recognize, Difficult to Diagnose Jeffrey L. Susman, MD; Benjamin F. Crabtree, PhD; Gregory Essink Arch Fam Med. 1995;4(5):427-431. Abstract Objective To explore rural family physicians' decisionmaking 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. Author Affiliations From the Department of Family Practice, University of Nebraska Medical Center, Omaha. THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Comorbid Chronic Illness and the Diagnosis and Treatment of Depression in Safety Net Primary Care Settings Ani et al. J Am Board Fam Med 2009;22:123-135. ABSTRACT | FULL TEXT   What Comprises Clinical Experience in Recognizing Depression?: The Primary Care Clinician's Perspective Baik et al. J Am Board Fam Med 2008;21:200-210. ABSTRACT | FULL TEXT   Conceptual Models of Treatment in Depressed Hispanic Patients Karasz and Watkins Ann Fam Med 2006;4:527-533. ABSTRACT | FULL TEXT   Barriers to the Diagnosis and Treatment of Depression in Jordan. A Nationwide Qualitative Study Nasir and Al-Qutob J Am Board Fam Med 2005;18:125-131. ABSTRACT | FULL TEXT   The Recognition of Depression: The Primary Care Clinician's Perspective Baik et al. Ann Fam Med 2005;3:31-37. ABSTRACT | FULL TEXT   How Many Problems Do Family Physicians Manage at Each Encounter? A WReN Study Beasley et al. Ann Fam Med 2004;2:405-410. ABSTRACT | FULL TEXT   Use, Quality, and Outcomes of Care for Mental Health: The Rural Perspective Rost et al. Med Care Res Rev 2002;59:231-265. ABSTRACT   The Role of Competing Demands in the Treatment Provided Primary Care Patients With Major Depression Rost et al. Arch Fam Med 2000;9:150-154. ABSTRACT | FULL TEXT   Diagnosis of depression in elderly patients Evans and Mottram Adv. Psychiatr. Treat. 2000;6:49-56. FULL TEXT   Combining qualitative interviews with video-recorded consultations: gaining insight into GPs' decision-making Coleman and Murphy Fam Pract 1999;16:173-178. ABSTRACT | FULL TEXT   False Positives, False Negatives, and the Validity of the Diagnosis of Major Depression in Primary Care Klinkman et al. Arch Fam Med 1998;7:451-461. ABSTRACT | FULL TEXT   Linking Primary Care and Rural Psychiatry: Where Have We Been and Where Are We Going? Lambert and Hartley Psychiatr. Serv. 1998;49:965-967. ABSTRACT | FULL TEXT   Management of Patients With Depression by Rural Primary Care Practitioners Hartley et al. Arch Fam Med 1998;7:139-145. ABSTRACT | FULL TEXT   Can Case-Finding Instruments Be Used to Improve Physician Detection of Depression in Primary Care? Klinkman et al. Arch Fam Med 1997;6:567-573. ABSTRACT   The 'Usual Care' of Depression Is Not 'Good Enough' Higgins Arch Fam Med 1997;6:340-341. ABSTRACT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1995 American Medical Association. All Rights Reserved.