Abstract
BackgroundFamily and friends may help patients seek out and engage in depression care. However, patients’ social networks can also undermine depression treatment and recovery. In an effort to improve depression care in primary care settings, we sought to identify, categorize, and alert primary care clinicians to depression-related messages that patients hear from friends and family that patients perceive as unhelpful or detrimental.MethodsWe conducted 15 focus groups in 3 cities. Participants (n = 116) with a personal history or knowledge of depression responded to open-ended questions about depression, including self-perceived barriers to care-seeking. Focus group conversations were audio-recorded and analyzed using iterative qualitative analysis.ResultsFour themes emerged related to negatively-received depression messages delivered by family and friends. Specifically, participants perceived these messages as making them feel labeled, judged, lectured to, and rejected by family and friends when discussing depression. Some participants also expressed their interpretation of their families’ motivations for delivering the messages and described how hearing these messages affected depression care.ConclusionsThe richness of our results reflects the complexity of communication within depression sufferers’ social networks around this stigmatized issue. To leverage patients’ social support networks effectively in depression care, primary care clinicians should be aware of both the potentially beneficial and detrimental aspects of social support. Specifically, clinicians should consider using open-ended queries into patients’ experiences with discussing depression with family and friends as an initial step in the process. An open-ended approach may avoid future emotional trauma or stigmatization and assist patients in overcoming self-imposed barriers to depression discussion, symptom disclosure, treatment adherence and follow-up care.
Highlights
And friends may help patients seek out and engage in depression care
The second phase analysis team members reviewed the transcripts and thematic categories and developed sub-codes specific to “negative cognitive and communicative processes related to social support.”
In our second phase of analysis, we identified four broad themes of codes and sub-codes relating to “negative cognitive and communicative processes related to social support”: feeling labeled, feeling judged, feeling lectured and feeling rejected
Summary
And friends may help patients seek out and engage in depression care. patients’ social networks can undermine depression treatment and recovery. In an effort to improve depression care in primary care settings, we sought to identify, categorize, and alert primary care clinicians to depression-related messages that patients hear from friends and family that patients perceive as unhelpful or detrimental. Perhaps because depressed patients rarely speak openly or spontaneously about their hurtful exchanges with friends and relatives [10], these types of comments, as related to depression, have not yet been systematically exposed. Documenting these messages has important implications for family-centered PCPs’ approach to depression identification and treatment. If clinicians are aware of the potential negative effects of such messages, they can consciously work collaboratively [19,20] to de-toxify these messages and potentially, improve the likelihood that patients will receive appropriate care [21,22]
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