Aspects of the relationship between doctors and depressed patients that enhance satisfaction with primary care.

Depression will be the second most common threat to health by the end of the next decade. The incidence of depression in primary care is already high. This has serious implications for the types of services available, the range of personnel who deliver them and the extent to which patients are helped by the treatments provided. Research reveals that approximately two-thirds of patients with depression are treated with medication, although it is not known how effective medication is in the long term. It would appear that the relationship between the patient and prescriber is a highly significant factor in determining whether or not patients adhere to treatment regimens and to what extent they improve. This study used a qualitative approach to identify how patients treated with medication for their depression perceived the relationship with their prescribing clinician, what kinds of information and advice they received and what they wanted. Several aspects of the helpful relationship are identified, such as the characteristics and behaviour of the clinician, as well as the way in which information is imparted. The frequency of monitoring consultations and patients' perceptions of their importance were also examined. The issue of stigma, particularly self-stigma and what can be done to prevent it, is discussed. The paper concludes with suggestions for improving the quality of primary care for patients' prescribed medication for depression, and especially for making maximum use of the initial consultation. The main implication for mental health nurses is that central to all interventions for depression is the primacy of the relationship, without which, clients' belief in treatment is diminished.