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In two separate studies, Betsy Sleath, professor of pharmacy, found that patients suffering from depression are not being diagnosed by their doctors. Sleath conducted one study with rheumatoid arthritis patients and the other with doctors of new mothers.
In the arthritis study, Sleath interviewed 200 patients from four rheumatology clinics with eight participating doctors. She audio taped patient visits and questioned patients after their medical visits to assess depressive symptoms.
Sleath found that nearly 11 percent of rheumatoid arthritis patients have symptoms of depression that range from moderately severe to severe. Patients whose pain limits their normal activities are twice as likely to have clinical depression as are other arthritis patients.
But all patients are unlikely to talk to their doctors about it.
Only one of five patients who showed signs of depression discussed it with a rheumatologist. Those who did discuss it were always the ones to raise the issue, Sleath said, not the doctors. And the subject was often not discussed at length.
“Chronic diseases can greatly affect a patient’s psychosocial well-being,” Sleath said, “and depression can also affect a patient’s adherence to treatment regimens.”
Since many arthritis patients see their rheumatologist more often than their primary-care doctors, she recommends that rheumatologists screen patients for signs of depression.
Sleath points out that rheumatologists can treat depression themselves. They can also refer patients to a mental health professional or contact the patient’s primary-care physician to coordinate a treatment plan. She suggests that rheumatology training programs should educate physicians about the importance of screening for and treating depression.
In a previous study on postpartum depression, Sleath found a similar void in consultation. She sent 1,200 surveys to obstetricians, gynecologists and family practitioners across North Carolina. From the 491 respondents, 228 said they had seen women for postpartum visits in the last three months, but 79 percent of these doctors were unlikely to screen patients for postpartum depression.
“I was really surprised that more doctors are not using formal screening instruments that are out there,” Sleath said.
She suggests using the Edinburgh Postnatal Depression Scale and the Patient Health Questionaire 9 — both of which can be found with a quick Internet search. As for one-on-one consultation, Sleath said that doctors were under a lot of pressure to focus on physical health instead of mental well-being.
“And North Carolina is not unique. For years, postpartum care has focused solely on the mother’s physical health,” she said. “But one out of nine new mothers has postpartum depression. I think that’s a pretty striking number.”
Only 43 percent of doctors said they were almost certain to ask mothers if they felt depressed or sad, and just 27 percent said they asked if new mothers were interested in their normal daily activities.
One way to make sure postpartum depression does not spiral out of control is for new mothers to talk about how they feel, if not first with their doctors then with their partners, friends and family. That is not easy, Sleath said, because women who suffer from postpartum depression typically feel ashamed that they are depressed during such a special time.
But if women don’t talk and doctors don’t ask, then new mothers who need treatment might never get it.
Provided by the Division of Research and
Economic Development
Writer: Mark Derewicz
Editor: Neil Caudle