1. Maybe yes, maybe no: Arguments about stigma and depression in interviews with family physicians Linda M. McMullen University of Saskatchewan, Canada

2. Introduction stigma varies with the diagnosis the stigma of a diagnosis of depression is complicated who stigmatizes?

3. Methodology and Methods discourse analysis individual interviews with 11 family physicians (5 women, average age = 51 yrs, average yrs in practice = 21, most in full-time practice [public, private, salaried]) two parts to the interviews 20 extracts contained the word stigma

4. Analysis: Qualifying Stigma Extract #1 Hedging the statement that there is less stigma I: Any sense of kind of why the younger crowd might be easier? P: Umm. Well, just uh their access to information is so much greater and I dont know maybe theres less I dont know maybe theres less stigma now than there was. Um I Im not really sure but theyre theyre more comfortable coming in and talking about things. Just like theyre more comfortable coming in and asking for contraception theyre more comfortable coming in to talk about um screening for sexually transmitted diseases theyre more comfortable talking about like hey Im a lesbian things like that so.

5. Extract #2 Hedging, then denying and casting suspicion on the statement that there is less stigma P: Just because of the uh stigma with uh with uh psychiatric illness and the weakness the people are perceived to be if theyre... if its in your head then its something you can get rid of, youre, just got to be stronger. And its amazing uh peoples families support that too they want the people to be better so they should just pull their socks up and do it? I: Okay okay so those kinds of attitudes even within the family P: I I think very strongly in the family um maybe its getting a little better in the years Ive been practicing but I dont think so I: Yeah its kind of tough to say P: you know I think were getting some lip service too but not necessarily a deep understanding for it

6. Extract #3 Separating the stigmatized condition of depression from the less stigmatized acts of seeking treatment and being on antidepressants P: Theres still a lot of stigma to to having a depressive illness but its more acceptable to have that stigma because you can get better without being put into hospital. I: Okay do you mean kind of like theres somewhat less risk maybe in talking about depression and mental illness or P: Its no longer associated with having to be put into hospital so there isnt going to be that uh great change in your life which will drag on after you because you were in the mental hospital. So its more acceptable to to come for treatment without without getting very very sick. Yeah I think thats thats a good way of putting it. Yes. Something can be done about it. Thats it. Yes.

7. Extract #4 Claiming less stigma, but then undermining the evidence P: Uh well I think the sense that theyre asking for it means its theres less stigma associated with the um depression um unfortunately that some of the other mental illnesses is still not a not accepting you know schizophrenia is very very um just very frowned upon but depression almost seems like its a its almost a socially acceptable thing its almost like a I dont want to say that the pendulum has swung so far that its cool to be depressed but its almost like its almost like its headed that way. So its sort of the fact that people are asking for medications reflects a shift in the population that its its now acceptable to ask for it. Um we we were talking about this earlier but it also reflects uh {pause} like society is very consumer minded. We like to buy things big screen TV nice stereo nice car. Its almost like antidepressant medications are like in the seventies everyone was on Valium. I: Its a designer kind of drug yeah. P: Yeah yeah its almost like its in fashion or its its its fashionable to be on them you know what I mean. People will be at the gym and so what are you on? Oh Im on [name of drug name]. Were not there yet but it it almost looks like its heading that way.

8. Discussion How might we understand the use of qualified arguments about stigma and depression? many uses of the word depression difficult to know what constitutes evidence of less stigma How might we understand the relative absence of talk of stigma in these interviews? Implications – anti-stigma campaigns for depression?