Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care


  • Jean S. Anthony PhD RN,

    Assistant Professor, Corresponding authorSearch for more papers by this author
    • Jean S. Anthony, PhD RN, is a an assistant professor at University of Cincinnati College of Nursing in Cincinnati, OH.

  • Seong-yi Baik PhD RN,

    Associate ProfessorSearch for more papers by this author
    • Seong-yi Baik, PhD RN, is an associate professor at the University of Louisville, College of Nursing, Louisville, KY.

  • Barbara J. Bowers PhD RN,

    Dean of ResearchSearch for more papers by this author
    • Barbara J. Bowers, PhD RN, is dean of research at the University of Wisconsin-Madison and faculty of health at the Australian Catholic University.

  • Bassirou Tidjani PhD,

    Associate ProfessorSearch for more papers by this author
    • Bassirou Tidjani, PhD, is an associate professor at the School of Business, University of Darkar—West Africa, and adjunct professor in the Department of African American Studies at the University of Cincinnati.

  • C. Jeffrey Jacobson PhD,

    Assistant ProfessorSearch for more papers by this author
    • C. Jeffrey Jacobson, PhD, is an assistant professor at the University of Cincinnati, College of Anthropology.

  • Jeffrey Susman MD

    Chair of the DepartmentSearch for more papers by this author
    • Jeffrey Susman, MD, is chair of the Department of Family Medicine at the University of Cincinnati, College of Medicine.


The objective of this study was to identify conditions that influence primary care clinicians' referral decisions related to depression care. Forty primary care clinicians (15 general internists, 10 nurse practitioners, and 15 family practice physicians) were included in this study. The clinicians participated in semistructured interviews and completed two quantitative instruments (with 33 items on depression treatment decision making and 32 items on provider attitudes toward psychosocial care). Data analysis revealed that several conditions influence a clinician's decision to refer a depressed patient to a mental health specialist: the patient's resources, the clinician's comfort in prescribing antidepressants and counseling patients with depression, and familiarity with a mental health specialist and practice environment. The decision to refer a patient with depression to a mental health specialist is a complex process involving the clinician, patient, and practice-related issues. Understanding these relationships may provide strategies to improve depression care management and lead to the design of depression care quality-improvement interventions that accommodate primary care practice context. The findings from this study suggest a need to increase mental health training opportunities for primary care clinicians to strengthen their skills and comfort level in managing depressed patients and encourage the development of relationships between primary care clinicians and mental health specialists to facilitate timely and accessible mental health care for patients.