Increasing Awareness to Identify and Address Depression Self-Stigma in Primary Care

Background: The prevalence of depressive disorders continues to rise across diverse populations and age groups. The diagnosis and initial management of depression frequently occur in a primary care setting though research shows only a fraction of patients will continue medication as prescribed or follow through with a referral. One barrier to depression treatment is self-stigma, the internalization of mental illness stigma that leads to a “why try” effect and worsens treatment engagement and outcomes. Although mental health stigma has been increasingly addressed as a public health concern, more can be done to combat stigma in the patient-to-provider interactions. Purpose: Introduce the concept of self-stigma to healthcare providers, including questions to identify self-stigma and strategies to re-shape thinking about depression treatment to enhance patient and family education about depression. Methods: A brief, one-time educational intervention was offered to an interprofessional team of healthcare providers at an integrated community health center during a routine monthly staff meeting. Following the presentation, an online post-survey was distributed to collect data on participants’ intention to change depression patient education to include evaluating for and addressing signs of depression self-stigma. Results: The post-survey analysis indicates that the educational intervention resulted in advancement in understanding the impact of self-stigma for patients with depression. There was a modest improvement in average scores in the likelihood of implementing what was learned into practice. However, more comprehensive training on depression management and community resources would be beneficial. Conclusions: There are many barriers for patients to follow through with depression treatment recommendations. One modifiable barrier is depression self-stigma. This quality improvement project demonstrates the value of brief training to increase awareness about mental illness stigma so that stigma education can be passed on to patients and families. Stigma education may be most effective as part of continuing education regarding depression assessment and treatment