The explanatory models of depression and anxiety in primary care: a qualitative study from India

The paper describes findings of a cross sectional qualitative study nested within a large randomized controlled trial (the Manas trial). Semi structured interviews were conducted with 117 primary health care attendees (30 males and 87 females) suffering from CMD. Main findings of the study are that somatic phenomena were by far the most frequent presenting problems; however, psychological phenomena were relatively easily elicited on probing. Somatic phenomena were located within a biopsychosocial framework, and a substantial proportion of informants used the psychological construct of ‘tension’ or ‘worry’ to label their illness, but did not consider themselves as suffering from a ‘mental disorder’. Very few gender differences were observed in the descriptions of symptoms but at the same time the pattern of adverse life events and social difficulties varied across gender.Our study demonstrates how people present their illness through somatic complaints but clearly link their illness to their psychosocial world. However they do not associate their illness to a ‘mental disorder’ and this is an important phenomenon that needs to be recognized in management of CMD in primary settings. Our study also elicits important gender differences in the experience of CMD.Depressive and anxiety disorders, which are collectively referred to as Common Mental Disorders [CMD], are typically encountered in primary health care settings [1,2]. One of the biggest challenges to the effective treatment of the disorders at the primary care setting is the low rate of recognition of CMD by primary health care workers. A leading reason attributed to explain this low recognition is the dominant somatic presentations of CMD [3-5]. ‘Somatization’ has been defined as the ‘presentation of somatic symptoms in place of personal or social problems which includes an avoidance of speaking about emotional distress by focusing on bodily sensations' [6]. Previous authors have observed that somatization is a c