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Table 1 Dimensions and themes concerning the non-seeking of medical care during a depressive episode as revealed by the qualitative analysis

From: Why underserved patients do not consult their general practitioner for depression: results of a qualitative and a quantitative survey at a free outpatient clinic in Paris, France

Dimension n Coded types
1. Treatment of depression 29  
a) Reluctance:   
 - The inefficacy of drugs. 5 “when stop the treatment, you become ill again” (1.21) “to heal, just talk about it. medications don’t work” (7.18.22)
 - The possibility that the physician would prescribe drugs with side effects. 2 “fear that the GP will give me medications” (10.30)
 - Afraid of the duration and complexity of the treatment. 3 “fear of embarking on a long and complicated treatment” (5.21.25)
 - Afraid of the side effects of drugs. 9 “medications aren’t good for your health; they don’t help you feel better” (
“medications are dangerous, especially if you’re young” (13)
“medications aren’t good for your health. they cause dependencies” (
 - Afraid to face reality. 2 “I might not want to hear things about my life, so I don’t talk about them” (10) “sometimes, it’s best not to try to find out why you’re not doing well” (10. 11)
b) Psychiatrist better suited than a GP. 5 “I prefer to get the appropriate treatment” (1.3.4)
“it can be treated with psychotherapy. no medications” (1.20.29)
“psychiatrists are better suited than GPs” (1.29)
c) Trust in God:   
 - God can heal. 3 “I prefer to trust in God for healing” (6.12.23)
 - Prayer can heal. 2 “the best thing for healing is prayer” (12.19)
d) Not believing that treatment is necessary:   
 - I know why I’m depressed, so if I solve the problem, I’ll feel better. 19 “always a reason” ( “depends on your life events” (
“all you have to do is solve your problems” ( “just fatigue or working too much” (8.20.27)
 - I don’t think I’m depressed (enough). 8 “being in denial” (
“a bit depressed”(1.16.24) “temporary depression” (1.10.16)
2. Perception of depression 26  
a) Loss of self-worth (poor self-image):   
 - Shame of being depressed. 9 “shame” (
 - Feeling guilty towards society. 5 “I feel guilty towards others about being depressed” (
 - Depression is a weakness. 7 “being depressed is being weak” ( “being depressed is being weak” (7.8.19)
 - Lack of virility*. 2 “men can’t be depressed” (8.24) “It’s a virility problem” (8)
b) Stigmatization:   
 - Afraid of being judged by society. 3 “afraid of being judged by others” (5.17.30)
 - Afraid of being considered crazy. 3 “afraid of being considered crazy by others” (13.17.28)
 - I’m afraid of being categorized by society or my friends and family. 4 “when you’re depressed, people stop talking to you” (
c) Mental health problems are not diseases. 13 “not an illness” ( “just some malaise” (2.7.18)
d) Depression is a taboo subject. 4 “taboo subject” (8.17) “people don’t talk about mental illnesses” (10.28)
e) I have a family history of depression and don’t want to follow suit. 5 “I know people in my family who are depressed, and I don’t want to be like them” ( “my mother suffered from depression, and I don’t want to be like her” (5)
3. Social environment 20  
a) Someone at home to talk to. 12 “I have good support at home” ( “it gets healed with help from the people around you” (1.3.14) “family needed for healing” ( “you just need to talk to your friends or family” (
b) Afraid to bother those around him/her. 4 “I don’t want to bother those around me with this problem” (
c) Incompatibility with social status:   
 - Prohibited because of social status. 4 “a high social status means you can’t be depressed” (8.29) “I project to others the image of someone who’s strong” (9.15)
 - Prohibited because of role among family and friends. 2 “friends and family distance themselves from depressed people” (5.19)
4. Doctor-patient relationship 14  
a) Not knowing a doctor to talk to   
 - No GP to talk to. 2 “I’ve never had a doctor I could talk to about it” (5.11)
 - Don’t know who to talk to. 2 “I don’t know who to talk to about it” (2.8) “I didn’t know that I could talk to my doctor about it” (2.8)
 - Don’t know GP well enough. 4 “I don’t have a doctor who knows me well enough to talk about it” (
b) Neglect on the part of the GP   
 - The GP wouldn’t listen to the complaint 3 “my doctor couldn’t care less about psychological problems” (24.26) “he doesn’t’ listen to me when I talk to him about my mood” (2)
 - Bad experiences with GP 1 “I’ve had bad experiences with doctors” (2)
c) Not a GP’s role   
 - The GP could not look after this problem. 3 “Doctors tend to real illnesses, not psychological problems” (8.16.24)
 - Afraid to bother GP. 8 “I don’t’ want to bother my doctor with this minor problem” (