Barriers and facilitators to the diagnosis and treatment of depression in Primary Care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives

Introduction
Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders’ experiences with the integration of mental healthcare into the primary care system.

Methods
The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data.

Results
Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

Discussion
This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.