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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” (4.5.6.11.14.15.27)
“medications are dangerous, especially if you’re young” (13)
“medications aren’t good for your health. they cause dependencies” (11.13.15.24)
 - 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” (1.2.4.5.6.7.8.23) “depends on your life events” (2.4.6.7.9.12.14.15.18.27)
“all you have to do is solve your problems” (1.5.7.14.16.22.26) “just fatigue or working too much” (8.20.27)
 - I don’t think I’m depressed (enough). 8 “being in denial” (7.10.13.19.21.24)
“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” (3.8.10.11.13.15.17.28.30)
 - Feeling guilty towards society. 5 “I feel guilty towards others about being depressed” (2.19.22.25.28)
 - Depression is a weakness. 7 “being depressed is being weak” (8.9.14.15) “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” (2.8.17.29)
c) Mental health problems are not diseases. 13 “not an illness” (1.4.7.8.9.11.12.14.15.23.26) “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” (9.13.16.25) “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” (1.2.8.18) “it gets healed with help from the people around you” (1.3.14) “family needed for healing” (4.11.16.18.26) “you just need to talk to your friends or family” (2.7.10.11.14.26)
b) Afraid to bother those around him/her. 4 “I don’t want to bother those around me with this problem” (2.13.24.27)
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” (1.17.22.27)
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” (1.2.16.18.20.24.26.28)