How patients with depressive symptoms view their condition: a qualitative study

Charles S. Cornford · Joseph G. Reilly

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Mental Health Treatment and Access Patient-Provider Communication in Healthcare Treatment of Major Depression

Abstract

BACKGROUND: Depressive symptoms are common in primary care, yet considerable professional controversy exists about appropriate management including the effectiveness of treatments. In addition, avoiding prescribing antidepressants at least initially is recommended. Views of patients themselves should therefore be particularly important in agreeing management strategies. OBJECTIVE: To examine lay beliefs about depressive symptoms in primary care. METHOD: A total of 23 semi-structured interviews were conducted with patients scoring positively for depression on the Hospital Anxiety and Depression Score in a primary care setting. RESULTS: Differentiating 'depression' from understandable reactions to adversity was difficult for patients. The wide range of consequences discussed included adverse effects on others, difficulties coping with feeling out of control and loss of self-identity. Negative images of depression, such as depression being a 20th century phenomenon, were pervasive. Views about medication varied. Various management strategies described included strategies of detachment, engagement in activities and 'blotting out' symptoms. CONCLUSIONS: Patients' views about depressive symptoms are significantly different from conventional medical views. A 'disease management approach' fits uncomfortably with patients' experiences. Acknowledging feelings of loss of control and loss of self-identity in consultations may be useful. The wide employment of techniques patients use to control their disorders, such as support from others, engagement in activities and working at relationships, may be useful to encourage in consultations as alternatives to the use of antidepressant medication.

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1983The Hospital Anxiety and Depression Scale 2008Qualitative Data Analysis 1996Qualitative data analysis (2nd ed)2001The world health report 2001 - Mental health: new understanding, new hope 1999Doing Interpretative Phenomenological Analysis 1986Social support, self-esteem and depression 2000Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial 1996Lay people's attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch

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