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General practitioners' views about diagnosing and treating depression in Maori and non-Maori patients

DOI:10.1071/HC10208
Authors:
David R Thomas at University of Auckland
David R Thomas
Brooke Arlidge
Brooke Arlidge
Brooke Arlidge
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Bruce Arroll
Bruce Arroll
Bruce Arroll
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Hinemoa Elder at Te Whare Wānanga o Awanuiārangi
Hinemoa Elder
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The study investigated general practitioners' (GPs') views about recognising and treating depression among patients to establish possible reasons for reported lower levels of diagnosis and treatment of depression among Maori compared to non-Maori patients. Semi-structured interviews with 23 GPs in the Auckland region, including both Maori and non-Maori GPs, elicited GPs' views about risk factors for depression, recognising depression and circumstances in which GPs would prescribe medication or recommend other treatments for depression. A framework was developed which incorporated the strategies GPs reported using to diagnose and treat depression. This consisted of three categories: (a) how depression is identified, (b) factors influencing treatment decisions, and (c) treatment outcomes. Reasons reported by GPs as most likely to lead to ethnic differences in diagnosing depression were greater stigma relating to admitting depression among Maori patients, Maori patients being less likely to talk about being depressed, and the need for patients to have effective communication with their GP. Effective communication, where Maori patients felt free to talk about personal feelings, was more likely when there was an established relationship between the GP and patient. The findings are consistent with previous reports that depression is less likely to be diagnosed by GPs among Maori patients, compared to non-Maori patients. GPs who are able to establish effective communication with patients, gain their trust and take account of the reluctance of some Maori patients to talk about personal feelings, are more likely to diagnose and treat depression effectively.
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... This is concerning as the prevalence of mental health disorders has previously been reported to be similar or possibly higher in Māori compared to non-Māori New Zealanders [37]. In two earlier studies, depression in Māori was shown to be less likely to be diagnosed by a general practitioner (GP) compared to non-Māori patients [38,39], with a lack of effective and/or culturally appropriate patient-doctor communication being cited as the primary reason [40]. A sense of trust between the patient and the GP was identified as being essential for Māori patients before admitting to depression symptoms, though it was also shown that there was often a disconnect between the patient and the GP about expectations regarding treatment [40]. ...
... In two earlier studies, depression in Māori was shown to be less likely to be diagnosed by a general practitioner (GP) compared to non-Māori patients [38,39], with a lack of effective and/or culturally appropriate patient-doctor communication being cited as the primary reason [40]. A sense of trust between the patient and the GP was identified as being essential for Māori patients before admitting to depression symptoms, though it was also shown that there was often a disconnect between the patient and the GP about expectations regarding treatment [40]. A further study suggested that Māori men, in particular, were less likely to consult a doctor for medical advice and that some women instead presented to the GP with proxy symptoms, highlighting the need for appropriate whānau (family) level care in some sit-uations [41]. ...
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... [13] A study of Māori and non-Māori patients found that Māori patients have a preference against antidepressant medication. [14] This was consistent with views expressed in the current study. ...
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... An example of how multiple levels of themes can be reported as a summary table at the beginning of the findings is shown in Table 13.5 below. The example is from a study of how family doctors diagnose and treat depression among Maori clients (Thomas, Arlidge, Arroll & Elder, 2009). Reporting themes in this way provides a useful overview that can help readers better grasp the project's main findings. ...
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... This is particularly the case amongst Māori, as Māori have reported 'whakamā' ('shyness' or 'embarrassed') as a potential barrier to using health services or from fully disclosing their health issues (Cram, Smith & Johnstone, 2003). For instance research have found Māori patients to be less likely to talk about symptoms of depression with their clinician (Thomas, Arlidge, Arroll & Elder, 2010). ...
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