Table 3.

Some Barriers to Recognition, Diagnosis, and Optimal Treatment of Depression^*

Patient Factors	Physician Factors	Health Care System Factors
Denial, minimization of symptoms,believing can handle by self	Not believing it is real illness, very serious,or particulary distressing	Time constraints
Not seeing as medical in nature	Interviewing skills deficiencies	Other pressing clinical issues
Concerns about confidentiality	Medicalization of symptoms	Limitations on third-party coverage
Not ready to accept diagnosis	Fear of offending patient	Limited treatment resource availability
Fear of treatments or nonadherencewith treatment plan	Knowledge deficit regarding diagnosis and/or treatment	Restrictions on access to particulartreatments
Stigma of mental health treatment	Diagnosis obscured by comorbidity	Fragmentation of care

^*Modified from Goldman.⁸²