Rural doctors less likely to diagnose depression in men than in women

A new study in a rural general practice has found that general practitioners are less likely than their patients to diagnose depression among men.

It is known that doctors are generally less likely to diagnose depression in men than in women. Little research has been undertaken to explore the reasons for this in rural settings, or to compare GPs' and male patients' assessments of perceived depression.

The study, published in the September issue of the British Journal of Psychiatry, was conducted at a general practice in a relatively prosperous rural area of Cheshire. During the year of the study, 982 men of working age attended the surgery, of whom 92% agreed to participate.

Three forms were used to collect baseline data:

• a self-administered health and well-being questionnaire, encompassing demographic details, anxiety and depression
• the GP's opinion of the patient's psychological state at the first consultation in the study, including the same depression scale used in the patient questionnaire
• a record from the patient's practice notes of the number and types of consultations in the 12-month period before the study began, including use of mental health services, hospital admissions and previously diagnosed mental disorders.

The diagnostic criteria set for depression in this study included both 'probable' and 'possible' cases.

A depression prevalence rate of 14% was found, higher than that recorded in previous studies reporting rates categorised by gender and social setting.

A range of recently experienced physical symptoms was associated with depression. Two of them - chest pain, and feeling tired or having no energy – retained this significant association after other symptoms, and socio-demographic and clinical variables, were taken into account.

In terms of independent effects on depression, only one demographic or socio-economic patient factor - job enjoyment - was found to be statistically significant. The researchers also found that previous depression was significantly associated with current cases during the study.

There were considerable differences between GPs' and patients' ratings of reported depression. Patients were significantly more likely to consider themselves depressed than were their doctors. The proportion of missed cases of depression was higher for the GPs, although the doctors had fewer false positives overall.

The researchers comment that their finding of a significant link between low job enjoyment and depression is consistent with previous research exploring the different attitudes of inner-city, semi-rural and suburban GPs to the interpretation and management of depression.

Why was there such a large difference between GPs and patients' assessments of depression? Previous research suggests that 'psychological' symptom patterns may be categorised differently by doctors and their patients. There is also evidence that patients tend to complain about physical symptoms before psychological ones.

More evidence is required that would allow greater insight into why patients with various characteristics, and in a particular social setting, have specific risk factors associated with depression, and how these are affected by GPs' diagnostic skills.

Educational interventions aimed at addressing the diagnosis of depression in men should take greater account of social factors.