Silent Suffering – Nondisclosure of Depression Symptoms

The lifetime prevalence of a major depressive disorder in the United States is nearly 20%. Unfortunately, many cases of depression are undiagnosed owing to nondisclosure of depression symptoms by patients. A new study evaluates the reasons for nondisclosure and emphasizes that we have a long way to go to erase the stigma associated with mental illness.

The study, published in the Annals of Family Medicine, was a follow-up survey of more than 1000 adults who had participated in a Behavioral Risk Factor Survey System. They were asked about reasons for nondisclosure of depression symptoms to their physician, as well as depression-related beliefs and demographic characteristics. Overall, 43% of the respondents reported at least one or more reasons for not disclosing symptoms of depression to their primary care physician. The most likely reason for nondisclosure was the fear that the physician would prescribe an antidepressant medication.

The reasons for nondisclosure among this sample varied according to demographic characteristics and depression history. For example, those with no history of depression were more likely to believe that depression did not fall under the purview of primary care. These individuals were also more fearful of being referred to a psychiatrist. Female gender, Hispanic ethnicity, and low socioeconomic status also predicted nondisclosure of depression symptoms.

The fact that depression symptoms are underreported and undertreated is not a new finding. Unfortunately, this is often due to the stigma associated with mental illnesses and disorders. As far as mental health treatment has come in the last few decades, most individuals have not let go of the individual stigma associated with depression and other disorders. On a population level, great strides have been achieved to reduce stigma and stereotypes associated with mental health, but, individually, many people are still willing to suffer in silence.

Concealing symptoms of depression has several consequences. The most obvious is, of course, that the depression remains untreated. However, the act of concealing symptoms also leads to decreased psychological well-being and physical health.

Interestingly, we are living in an era of social networks in which people continuously emote in public. But, these same people do not tell their physicians about legitimate psychological symptoms. A study of Facebook revealed that young adults commonly reveal symptoms consistent with depression in their displays. (Perhaps physicians need to be “friends” with their patients to truly assess their overall health and well-being.) Fortunately, many of these adults received an outpouring of support from online family and friends.

The bottom line is that people seem to not trust their physicians or the health care system enough to discuss issues that really matter. Is it the lack of time, the readiness to prescribe drugs, the stigma, or a loss of control that prevents full disclosure to primary care physicians? Essentially, the authors of the current study suggest that we still have a long way to go to make people understand what depression is and how it can be treated. Patients should be encouraged to share all symptoms — physical and psychological — with their physicians, and be an advocate for their own health.

References

Bell RA, Franks P, Duberstein PR, Epstein RM, Feldman MD, Garcia EF, & Kravitz RL (2011). Suffering in silence: reasons for not disclosing depression in primary care. Annals of family medicine, 9 (5), 439-46 PMID: 21911763

Garcia JA, & Crocker J (2008). Reasons for disclosing depression matter: the consequences of having egosystem and ecosystem goals. Social science & medicine (1982), 67 (3), 453-62 PMID: 18450349

Quinn DM, & Chaudoir SR (2009). Living with a concealable stigmatized identity: the impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. Journal of personality and social psychology, 97 (4), 634-51 PMID: 19785483

Moreno MA, Jelenchick LA, Egan KG, Cox E, Young H, Gannon KE, & Becker T (2011). Feeling bad on Facebook: depression disclosures by college students on a social networking site. Depression and anxiety, 28 (6), 447-55 PMID: 21400639

Image via Krivosheev Vitaly / Shutterstock.