摘要：Objectives. We examined the association between attributes of primary care providers and care for depression, from a patients’ perspective, among a sample of predominantly low-income African American women. Methods. Computer-assisted telephone interviews were conducted among a population-based sample of 1202 women residing in Washington, DC. Results. Respondents whose primary care physicians provided more comprehensive medical services were more likely to be asked about and treated for depressive symptoms than women whose providers were less medically comprehensive. Women who rated their providers as having more respect for them also were more likely to be asked about and treated for depression. Conclusions. More comprehensive primary care delivery and a physician–patient relationship focused on mutual respect are associated with greater rates of physician inquiry about and treatment for depression among vulnerable women. Depression, a common and often chronic disorder, is expected to become the second greatest cause of disability worldwide over the next decade. 1, 2 Depressive symptoms, with or without major depressive disorder, can impair functioning to levels comparable to or worse than those seen with chronic medical conditions such as congestive heart failure, diabetes, angina, and arthritis. 3, 4 Despite the chronic and debilitating course of this disorder and the existence of efficacious interventions, 5 most people with depression fail to seek mental health care; those who do seek care are most frequently seen in primary health care settings rather than psychiatric settings. 6– 8 Unfortunately, depression is underrecognized and undertreated in these general medical care settings, 9– 11 and there are inconsistencies in the process and quality of care for depression in primary care practices. 12 Therefore, an understanding of factors that influence identification and care for depression in this setting is important. Lower-income and non-White women are particularly unlikely to seek care in mental health settings 13 ; they are more likely to seek help from primary health care providers than are wealthier women and White women. 14 Yet, primary care providers are less likely to diagnose depression among African American women than among White women. 10, 15 Although research has examined primary care providers’ knowledge and communication style as factors in identifying depression, little is known about the attributes of primary care delivery systems as they relate to recognition and treatment of this condition. Because lower-income African American women are less likely to use mental health specialty providers than primary care providers for their psychosocial needs, 13, 14 we hypothesized that, among these women, those whose primary care providers offered more medically comprehensive services would be more likely to have their psychosocial needs met. In addition, we hypothesized that women whose primary care providers were more accessible, in terms of availability of appointments, hours of operation, and women’s ability to reach them by telephone, would be more likely to be asked about depressive symptoms. Previous studies have shown that better access enhances the likelihood of receipt of needed health care, first-contact care with a primary care provider, and provider continuity. 16, 17 We examined, among a community sample of predominantly low-income, African American women, associations between primary care attributes and care for depression, both assessed from the patient’s perspective.
