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A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK.

Maxwell, Margaret; Harris, Fiona; Hibberd, Carina; Donaghy, Eddie; Pratt, Rebekah; Williams, Chris; Morrison, Jill; Gibb, Jennifer; Watson, Philip; Burton, Chris


Margaret Maxwell

Fiona Harris

Carina Hibberd

Eddie Donaghy

Rebekah Pratt

Chris Williams

Jill Morrison

Jennifer Gibb

Philip Watson

Chris Burton


Background: Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Methods. Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. Results: We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. Conclusion: The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening. © 2013 Maxwell et al.; licensee BioMed Central Ltd.


MAXWELL, M., HARRIS, F., HIBBERD, C., DONAGHY, E., PRATT, R., WILLIAMS, C., MORRISON, J., GIBB, J., WATSON, P. and BURTON, C. 2013. A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK. BMC family practice [online], 14, article number 46. Available from:

Journal Article Type Article
Acceptance Date Apr 4, 2013
Online Publication Date Apr 4, 2013
Publication Date Dec 31, 2013
Deposit Date Sep 21, 2016
Publicly Available Date Sep 21, 2016
Journal BMC family practice
Electronic ISSN 1471-2296
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 14
Article Number 46
Keywords Depression; Case finding; Screening; PHQ9; Diabetes; Coronary heart disease; Primary care
Public URL


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