How do General Practitioners Deal with Patients they do not Consider to be Depressed but who are Classified as Such According the PHQ-9? A Qualitative Study

Objectives How GPs describe their patients who they did not identify as suffering from depression but who were classified as such by PHQ-9? What conclusions can be drawn with regard to how depression is dealt with and the illness model in use? Method GPs who took part in a screening study were asked in interviews to talk about some of their patients - not being informed that these were those not identified as depressive by them. This study comprises 21 narrative interviews from 18 GPs. Analysis by Framework method by Lewis and Ritchie. Results The low identification rate of depression is not the result of failed recognition of psychological problems" but of other factors centring on GPs' particular way of working and their concepts about mental illness: making a diagnosis only in a contextual way of interpreting symptoms; using the time passing as a help for diagnosing; emphasis on the impairment rather the diagnosis; considering the therapeutic consequences before making a diagnosis; a tolerance concerning deviation" respectively wider view on "normality". Conclusion Understanding the different ways of conceptionalizing mental illness by psychiatrists and general practitioners is basic for their cooperation.