Patients and Healers in the Context of Culture by Arthur Kleinman
The Spirit Catches You and You Fall Down by Anne Fadiman
Research Highlights 2005-2014
Bell, R. Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care. Ann Fam Med 2011;9439-446.
Telephone survey of adults asked about reasons for nondisclosure of depressive symptoms to their primary care physician. The most frequent reason was the concern that the physician would recommend antidepressants. Respondents with no depression history were more likely to believe that depression falls outside the purview of primary care and more likely to fret about being referred to a psychiatrist.
Blaire, E. Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here? Perm J. 2011 Spring; 15(2): 71–78.
Demands of a busy medical practice leave little time for reflection and the fulfillment of even the best intentions. Biases must be rendered less implicit and unconscious to foster real reflection, analysis and change. Gut reactions to specific individuals or groups may be potential indicators of implicit bias. Identify biases that may be active in the community. Affirm equity of care and diversity as core organizational and institutional values.
Givens, J. Ethnicity and Preferences for Depression Treatment. Gen Hosp Psych 29 (2007) 182–191
Survey of people with significant depressive symptoms. Compared to whites, African Americans, Asians/Pacific Islanders and Hispanics were more likely to prefer counseling to medications. Ethnic minorities were less likely to believe that medications were effective and that depression was biologically based, but were more likely to believe that antidepressants were addictive and that counseling and prayer were effective in treating depression.
Griffiths, K. Does Stigma Predict a Belief in Dealing with Depression Alone? J Aff Disorders, 2011.
Personal stigma predicted a belief in the helpfulness of dealing with depression alone. Men and older people were more likely to believe in coping alone with depression accompanied by suicidal ideation. Personal stigma might be one element that could be targeted in an intervention designed to encourage help seeking by those who prefer to deal with their depression alone or who believe that others should do so.
Kaner, E. Seeing Through the Glass Darkly? A Qualitative Exploration of GP’s Drinking and Their Alcohol Intervention Practices. Fam Pract Adv Access, 2006.
Alcohol is clearly a complex and emotive health and social issue and GPs are not immune to its effects. For some GPs’ shared drinking behavior can act as a window of opportunity enabling insight on alcohol issues and facilitating discussion. However, other GPs may see through the glass more darkly and selectively recognize risk only in those patients who are least like them.
Kuehn, B. Men Face Barriers to Mental Health Care. JAMA, Nov 15, 20006-Vol 296, No.19
Rather than presenting with depressed mood or sadness, men may report irritability, stress, somatic complaints, or cognitive dysfunction. Suggests physicians probe further and look for other signs such as weight loss, sleep problems, or individuals who feel or who appear to feel hopeless.
Lin, P. The Influence of Patient Preference on Depression Treatment in Primary Care. Ann Behav Med 2005, 30(2):164–173.
Participants with depression who preferred medication were older, were in worse physical health, and were more likely to already be taking antidepressants. Participants who preferred both medication and counseling evidenced greater agreement with the statement that depression is a medical illness. Matched participants demonstrated more rapid improvement in depression symptomatology than unmatched participants.
Pattyn, E. Public Stigma and Self-Stigma: Differential Association with Attitudes Toward Formal and Informal Help Seeking. Psych Services, 2014.
Respondents with higher levels of anticipated self-stigma had more negative attitudes toward seeking help from general practitioners and psychiatrists but not from non-medical specialists (psychologists). Some people seemed to fear devaluation and discrimination by their significant others. Psychoeducation of families and friends of people with mental illness would enhance the provision of lay support.