Contemporary paradigms for research related to women's mental health.

Mental health problems are serious health concerns that affect women across diverse settings internationally. Knowledge of this population historically has been informed by research using a positivist approach. This article is a critical examination of contemporary paradigms for research related to women's mental health. We begin the article with an introduction to women's mental health, followed by an overview of the postpositivist, critical theory, and constructivist paradigms. We then present a critical examination of the benefits and limitations of these paradigms in relation to the study of women's mental health. We conclude with implications for research and practice.

The needs of depressed women: perspectives of family physicians.

Twenty family physicians (11 female and 9 male) were interviewed about their experiences in treating depressed patients. Interview transcripts were analyzed thematically with respect to physicians' understanding of women's depression and their treatment strategies with depressed women. Stress arising in the social context of women's lives was perceived as a key precipitant of depression in women, with family-related, gender-specific and practical sources of stress as the main contributors. Physicians' treatment strategies had the aims of alleviating depressive symptoms and stress reduction. Implications of the findings for primary health care delivery and community-based interventions with depressed women are discussed.

Canadian mothers' perceived support needs during postpartum depression.

OBJECTIVE: To assess the support needs, support resources, barriers to support, and preferences for support intervention for women with postpartum depression. DESIGN: Multisite, exploratory, descriptive study in which qualitative data were collected on support needs, the availability of resources, perceived barriers to support, and preferences for support of women who have experienced symptoms of postpartum depression. PARTICIPANTS AND SETTING: Conducted in Alberta and New Brunswick; mothers were interviewed individually (Alberta, n= 24; New Brunswick, n= 17) and in groups (Alberta, n= 5; New Brunswick, n= 6). RESULTS: For most mothers, one-on-one support was preferred when postpartum depression is recognized. Group support should be available once the mothers start to feel better and are able to comfortably interact with other mothers in a group format. This suite of alternatives needs to be underpinned by concerted public education efforts.

Diagnosing depression: there is no blood test.

OBJECTIVE: To explore and describe primary care physicians' experiences in providing care to depressed patients and to increase understanding of the possibilities and constraints around diagnosing and treating depression in primary care. DESIGN: Qualitative study using personal interviews. SETTING: A hospital region in eastern Canada. PARTICIPANTS: A purposely diverse sample of 20 physicians chosen from among all 100 practising family physicians in the region. METHOD: Invitations were mailed to all physicians practising in the region. Twenty physicians were chosen from among the 39 physicians responding positively to the invitation. Location of practice, sex, and year of graduation from medical school were used as sampling criteria. The 20 physicians were then interviewed, and the interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative approach involving handwritten notes on transcripts and themes created using qualitative data analysis software. MAIN FINDINGS: Three themes related to diagnosis emerged. The first concerns use of checklists. Physicians said they needed an efficient but effective means of diagnosing depression and often used diagnostic aids, such as checklists. Some physicians, however, were reluctant to use such aids. The second theme, interpersonal processes, involved the investment of time needed for diagnosing depression and the importance of establishing rapport. The final theme, intuition, revealed how some physicians relied on "gut sense" and years of experience to make a diagnosis. CONCLUSION: Diagnosis of depression by primary care physicians involves a series of often complicated negotiations with patients. Such negotiations require expertise gained through experience, yet prior research has not recognized the intricacies of this diagnostic process. Our findings suggest that future research must recognize the complex and multidisciplinary nature of physicians' approaches to diagnosis of depression in order to better reflect how they practise.

Physicians' constructions of depression: inside/outside the boundaries of medicalization.

A qualitative study explored primary care physicians' experiences of diagnosing and treating depression. Twenty physicians participated in semi-structured interviews. Interview questions asked physicians to consider a range of topics such as the etiology of depression, the diagnostic process and treatment of depression. Transcripts were analyzed discursively with a view to exploring the ways in which physicians construct depression. In this article, physicians' constructions of depression are examined through exploration of their descriptions of this condition, as well as their recognition of the social context of depression. Based on this analysis, it was concluded that physicians' medicalized understandings of depression conflict with recognition of the social context of depression. The result of this conflict is dissonant descriptions of depression. One implication of this research is that physicians' training would benefit from the integration of multidisciplinary perspectives on depression, which would better reflect physicians' experiences in routine practice situations.

Barriers to treating depression in the family physician's office.

This qualitative research aims to understand, from the standpoint of the family physician, the barriers to treating depression in the office setting. Three primary barriers to treating depression in the family physician's office were identified: systemic, physician-related, and patient-related. The systemic barriers involved the shortage of qualified, publicly-funded counsellors, lack of locally available counselling, and the cost of medication. Physician-related barriers included lack of time and expertise, and inadequacies of the reimbursement system. Patient-related barriers were rooted in the stigma attached to depression and failure to comply with treatment.

The theme of disconnection in adolescent girls' understanding of depression.

Fourteen adolescent girls aged between 14 and 17 were interviewed concerning their understanding of depression. Individual interviews were semi-structured and included discussion about descriptions of, causes of, and coping with, depression. Interviews were transcribed verbatim and were analysed thematically. The dominant theme arising from the girls' interviews was that of disconnection from relationships. Possible reasons why disconnection seems to play such a large part in girls' understanding of depression are discussed.