Initially, a primary care physician is approached for the treatment of depression. However, asking about depression and suicide could confront a physician, emotionally and intellectually.
Also, primary care physicians do not have much time to collect information about many subjects, including sensitive issues such as depression.
"Some doctors, due to their personal preferences, traits or attitudes, are loathe to broach sensitive topics such as depression or suicide," said Paul R. Duberstein, Ph.D., professor of psychiatry at the Medical Center and lead author of the article.
He added: "There is not one right way to do this. A physician does not have to undergo a personality change to ask patients about depression. But physicians should reflect on the possibility that their personal traits might have implications for their approach to the assessment of depression and perhaps other mental health concerns."
He further added that some physicians, who hesitate in questioning about depression and suicide or who are unnerved by the inquiry, could use a screening questionnaire, said Duberstein.
"It is not surprising, therefore, that depression is frequently not diagnosed and physicians often do not inquire about suicidal thoughts," said the authors.
In the study, the researchers analyzed data, audiotapes and medical records from a study in which six actors, all of women were women, were trained to portray a patient with major depression or one with adjustment disorder with depressed mood. With prior physician consent and the cooperation of health plans, the actor-patients received insurance cards and other paperwork corresponding to their false identities.
The meetings with the physicians were taped using concealed tape recorders. The physicians, who were not informed when an actor was a patient, were internal and family medicine specialists in Rochester. In total, 46 physicians with 88 patient visits were studied.
All the physicians in the study were divided along three dimensions: dutifulness, vulnerability and openness to feelings. Dutiful suggests conscientiousness, the tendency to follow through reliably, as in paying bills on time. Vulnerability means anxiousness, the tendency to feel unsettled, moody and under stress. Openness indicates empathy, the capacity to understand the feelings of others.
"Doctors high in dutifulness are more likely to document a depression diagnosis but ask fewer questions about depression. They are no more (or less) likely to ask about suicide than their less dutiful peers," said the researchers.
They added: "Concern with time-economy could explain why, despite their apparent level of vigilance, they ask fewer questions about depression and are not more likely to inquire about suicide, arguably the most important symptom of depression. Perhaps they believe that asking about suicide will extend the office visit."
Also, physicians high in vulnerability were found to be more likely to document a depression diagnosis.
The study is published online this month in the Journal of General Internal Medicine.