TY - JOUR T1 - An evidence-based first consultation for depression: nine key messages JF - British Journal of General Practice JO - Br J Gen Pract SP - 200 LP - 201 DO - 10.3399/bjgp18X695681 VL - 68 IS - 669 AU - Bruce Arroll AU - Weng Yee Chin AU - Fiona Moir AU - Christopher Dowrick Y1 - 2018/04/01 UR - http://bjgp.org/content/68/669/200.abstract N2 - Depression is commonly understood as a psychological condition characterised by ≥2 weeks of low mood often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause. The prevalence of major depression in primary care is estimated to be about 13% (range 4–23%).Because doctors are usually trained to focus on physical aspects first, some may perceive that it is less problematic to miss a mental health diagnosis1 or may even evade enquiring about psychosocial issues to avoid opening Pandora’s Box (ironically in which lies hope).1 Some perceive that low mood related to loss may be better understood within a model of grief, choosing not to diagnose depression. Others have concerns about stigma or the impact on insurance claims if ‘depression’ is documented.2Empathic listening is key to gaining a shared understanding of the patient’s problems, including relevant cultural aspects. Actively listening shows respect, enhances rapport, builds trust, and enables a healing partnership. In addition to mental health concerns, there may be loneliness, comorbid physical conditions, family violence, sexual and physical abuse, crime, war, migration, or homelessness. Although there are reasons to avoid official labelling in primary care, it is important to identify psychological distress with or without the label.Making a mental health diagnosis for clinicians in primary care is challenging, and a depression diagnosis may be more accurate if made over more than … ER -