'For men only'. A mental health prompt list in primary care.

BACKGROUND: Barriers to detecting symptoms of depression in male patients in primary care include patients' reticence to self disclose and doctors' failing to ask questions that tap into their patient's emotional distress. Effective consultation is further hindered by time constraints, undifferentiated and nonspecific symptoms of depression, differing attribution of symptoms and expectations of the consultation, and low levels of mental health literacy. These issues, of particular relevance to men, informed the design of a screening instrument, the 'For Men Only' Prompt List (PL). OBJECTIVE: This article reports an evaluation by male patients and their general practitioners of the PL conducted in the context of primary care. The patients completed the PL in the waiting room and used it to raise issues during consultation. The instrument was evaluated using a short questionnaire completed by patients, a postal questionnaire by GPs, and field notes. DISCUSSION: The PL was useful for those patients who required prompting in raising issues surrounding depression. Those who already had a good relationship with their doctor, were at case discussing issues without prompting, or had a specific physical problem to be treated, did not find it as useful. All practitioners found the PL provided extra information about their patients. It also helped them build rapport with patients and made their job of assessment easier. Doctors depend on patients to self disclose and patients depend on doctors to provide an accurate diagnosis. The PL addresses some of the barriers to identifying depressive symptoms in men, particularly in assisting male patients to 'open up' to their doctors.

Screening for Depression in the Medically Ill: a comparison of self-report measures, clinician judgment, and DSM-IV diagnoses.

The performance of the self-report 10-item Depression in the Medically Ill scale was observed in 210 patients as part of clinical assessment by consultation-liaison psychiatry clinicians. Both the Depression in the Medically Ill scale and the Beck Depression Inventory for Primary Care were completed by the patient, and the clinicians made their judgment of the presence and severity of "clinical depression" and DSM-IV affective disorder diagnoses. Both the Depression in the Medically Ill scale and the Beck Depression Inventory for Primary Care detected 85% of patients with DSM-IV major depressive episode. The Depression in the Medically Ill scale was slightly superior to the Beck Depression Inventory for Primary Care in its relationship to clinicians' judgments of clinical depression caseness.