Better Doctor-Patient Relationships Are Associated With Men Choosing More Active Depression Treatment

David Kealy, PhD; Simon M. Rice, PhD; Olivier Ferlatte, PhD; John S. Ogrodniczuk, PhD; John L. Oliffe, PhD

Disclosures

J Am Board Fam Med. 2019;32(1):13-19. 

In This Article

Abstract and Introduction

Abstract

Background: Men tend to have low rates of treatment uptake for depression. The quality of the relationship with their family physician may be a factor influencing attitudes toward treatment. The present study was developed to explore this issue in a nationally representative sample of Canadian men.

Methods: An online survey of 1000 Canadian men was conducted to inquire about men's relationship with their family physician and hypothetical treatment choices for depression. Main analyses were conducted among 819 men who indicated having a regular primary care physician.

Results: Two thirds of men with a family physician (n = 534; 65%) indicated they would pursue treatment if they were suffering from depression. Multinomial logistic regression, controlling for age, employment, education level, and current depressive symptoms indicated that positive perceptions of the patient-doctor relationship were associated with men being more likely to opt for pharmacotherapy (n = 183; odds ratio [OR], 1.06; P < .001), and individual psychotherapy (n = 277; OR, 1.04; P < .001), compared with a wait-and-see/no treatment approach (n = 285).

Conclusion: The quality of the doctor-patient relationship is an important element in helping men choose active treatment for depression.

Introduction

One of the obstacles in addressing men's depression is their low uptake of treatment.[1] While reasons vary, traditional masculinity norms have consistently been identified as a limiting factor in men's uptake of treatment for depression.[2] An ideal of self reliance, for example, may equate acceptance of care with weakness, leading some men to prefer waiting—without treatment—for their depression to subside. Primary care often represents men's first point of contact in the identification, diagnosis, and treatment of depression,[3] and even persistent and treatment-resistant depression is frequently managed in primary care.[4] Thus, family physicians are likely to play a critical role in helping men take an active approach to treating mental health problems.

Given the prevalence of depression and suicide among men,[5] helping men to consider treatment for depression is an important public health priority. While several outreach and public messaging campaigns (eg, www.headsupguys.org; www.beyondblue.org.au; www.thecalmzone.net)[6–8] have sought to change attitudes about depression among men—aimed at reducing stigma and promoting help seeking—men's direct experience with health care providers remains an important medium for encouraging treatment. Despite focused efforts to enhance management of depression in primary care, including education to family physicians, screening/detection strategies, and specialized consultation or collaboration with psychiatry, treatment rates for depression in primary care are less than optimal.[3] While gender-based stigma may account for some of men's reluctance to accept treatment, other factors such as misinformation or concern about the experience of treatment or medication side effects may also be implicated.[9–11] Moreover, the patient-doctor relationship itself may be a notable barrier to—or facilitator of—the uptake of depression treatment in primary care.[12]

The quality of the patient-doctor relationship may be a fundamental vehicle for the shaping of men's attitudes toward treating mental health difficulties. The depth of this relationship, reflecting continuity in care, openness, and sensitivity to the patient's needs, might contribute to feelings of acceptance toward mental health concerns and confidence in recommended treatments. While tentative feelings about the primary care experience may influence a man's hesitation regarding active treatment,[9–10] a sense of being understood and cared for by his physician might incline him to consider pharmacotherapy or psychotherapy for depression.

The present study was developed to examine whether men's willingness to consider treatment for depression would be associated with the quality of their relationship with their family physician. We hypothesized that, if presented a hypothetical scenario of suffering from depression and considering several treatment options, men would be more likely to choose an active treatment approach if they experienced a positive relationship with their family physician. Since opting for treatment may well be motivated by the severity of depressive symptoms, we sought to control for depressive symptom distress in examining the role of the patient-doctor relationship.

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