چکیده (انگلیسی):

Background:The prevalence of depression in the general population is 5 to 10% but can exceed 50% in the most
socially vulnerable populations. The perceptions of this disease are widely described in the literature, but no
research has been carried out in France to explain the reasons for not consulting a general practitioner during a
depressive episode, particularly in people in the most precarious situations. The objective of this study was to
describe the reasons for not seeking primary care during a depressive episode in a socially vulnerable population.
Methods:An exploratory sequential design with a preliminary qualitative study using a phenomenological
approach. Subsequently, themes that emerged from the qualitative analysis were used in a questionnaire
administered in a cross-sectional observational study at a free outpatient clinic in Paris in 2010. Lastly, a logistic
regression analysis was performed.
Results:The qualitative analysis revealed four aspects that explain the non-consulting of a general practitioner
during a depressive episode: the negative perception of treatment, the negative perception of the disease, the
importance of the social environment, and the doctor-patient relationship. The quantitative analysis showed that
close to 60% of the patients who visited the free clinic were depressed and that only half of them had talked with
a care provider. The results of the statistical analysis are in line with those of the qualitative analysis, since the most
common reasons for not seeing a general practitioner were the negative perception of the disease (especially
among the men and foreigners) and its treatments (more often among the men and French nationals).
Conclusions:Close to 50% of the depressed individuals did not seek primary care during a depressive episode, and
close to 80% of them would have liked their mental health to be discussed more often by a health professional.
Better information on depression and its treatments, and more-systematic screening by primary care personnel
would improve the treatment of depressed patients, especially those in the most precarious situations.