Table 1 The theoretical domains and key findings

1. Knowledge

1.1. Doctors are depression aware but do not actively diagnose

1.2. Patients present with somatic symptoms of depression and do not talk about their feelings

1.3. Key motivations for consultation are insomnia and desire for a “leave-from-work certificate”

2. Optimism

2.1. Doctors perceive a sizable mental health treatment gap

3. Beliefs about consequences

3.1. Depression is not considered to be a treatment priority in CHC

4. Memory, attention and decision processes

4.1. No standardized guidelines for the management of depression at CHC

4.2. Two systems share responsibility for depression care: CHC are focused on initial assessments, general counselling and patient education; Hospital is focussed on diagnosis and treatment

4.3. Traditional Chinese Medicine plays a role in depression treatment

5. Skills

5.1. Limited awareness and use of depression scales/screeners by CHC doctors

5.2. Doctors are generally pessimistic about screener utility and effectiveness

5.3. Doctors actively choose time appropriate tools to support diagnosis

6. Beliefs about capabilities

6.1. Doctors receive limited professional development

6.2. Doctors’ confidence in their ability to treat is low

7. Social/professional role and identity

7.1. Doctors are not psychiatrists

7.2. Doctors protect patients from stigma by avoiding a depression diagnosis

8. Emotion

8.1. Doctors fear making treatment mistakes

8.2. Doctors are not attuned to providing psychotherapy

9. Environmental context and resources

9.1. High volume of patients and short consultation times at CHC

9.2. Limited trained mental health resource at CHC level

9.3. Limited trained mental health resource at hospital level

9.4. Patients lost to a developing referral system

9.5. Poor CHC ability to follow-up patients

9.6. No anti-depressants at CHC

9.7. Doctors without access to anti-depressants are un-empowered to treat

9.8. No private space/designated consultation room for mental health conditions

10. Social influences

10.1. Poor general/community health literacy

10.2. Chinese underlying culture: loss of face accentuates poor health seeking

10.3. Intense stigma associated with the main speciality hospital

10.4. Community induced isolation and discrimination

10.5. Family members are important facilitators for patient care

10.6. Poor family understanding of depression can lead to poor treatment outcomes

10.7. Poor employer attitudes towards depression

10.8. A climate of poor public-opinion and trust in the medical profession

11. Behavioral regulation

11.1. Require depression-specific policies for patient reimbursement

11.2. Require doctor incentivisation (like psychosis polices)

11.3. “One psychiatric doctor per community health centre” facilitates passing down and cross-referral

11.4. Establishment of dedicated mental health department at local hospitals

11.5. Review of “five in one policy”

11.6. Stronger health promotion on world mental health day

11.7. Use of e-health to vitalize resource and reach more patients

12. Reinforcement

12.1. Improved doctor training with special instruction in mental health

12.2. Access to Western Medicine and improved consulting environment

12.3. Improved mental health literacy

13. Intentions and 14. Goals

13.1. The care of depression patients to be more strongly prioritised

13.2. Good psychological health is an important component for quality of life

13.3. Timely management of depression prevents suicide