Abstract
BackgroundThe prevalence of depression in people with coronary heart disease (CHD) is high but little is known about patients’ own perceptions and experiences of this. This study aimed to explore (i) primary care (PC) patients’ perceptions of links between their physical condition and mental health, (ii) their experiences of living with depression and CHD and (iii) their own self-help strategies and attitudes to current PC interventions for depression.MethodQualitative study using consecutive sampling, in-depth interviews and thematic analysis using a process of constant comparison. 30 participants from the UPBEAT-UK cohort study, with CHD and symptoms of depression. All participants were registered on the General Practitioner (GP) primary care, coronary register.ResultsA personal and social story of loss underpinned participants’ accounts of their lives, both before and after their experience of having CHD. This theme included two interrelated domains: interpersonal loss and loss centred upon health/control issues. Strong links were made between CHD and depression by men who felt emasculated by CHD. Weaker links were made by participants who had experienced distressing life events such as divorce and bereavement or were living with additional chronic health conditions (i.e. multimorbidity). Participants also felt ‘depressed’ by the ‘medicalisation’ of their lives, loneliness and the experience of ageing and ill health. Just under half the sample had consulted their GP about their low mood and participants were somewhat ambivalent about accessing primary care interventions for depression believing the GP would not be able to help them with complex health and social issues. Talking therapies and interventions providing the opportunity for social interaction, support and exercise, such as Cardiac Rehabilitation, were thought to be helpful whereas anti-depressants were not favoured.ConclusionsThe experiences and needs of patients with CHD and depression are diverse and include psycho-social issues involving interpersonal and health/control losses. In view of the varying social and health needs of patients with CHD and depression the adoption of a holistic, case management approach to care is recommended together with personalised support providing the opportunity for patients to develop and achieve life and health goals, where appropriate.
Highlights
The prevalence of depression in people with coronary heart disease (CHD) is high but little is known about patients’ own perceptions and experiences of this
Strong links were made between CHD and depression by men who felt emasculated by CHD
Just under half the sample had consulted their General Practitioner (GP) about their low mood and participants were somewhat ambivalent about accessing primary care interventions for depression believing the GP would not be able to help them with complex health and social issues
Summary
The prevalence of depression in people with coronary heart disease (CHD) is high but little is known about patients’ own perceptions and experiences of this. There has been increasing recent interest in multimorbidity and the bi-directional relationship between conditions such as coronary heart disease and depression in primary care [6]. Gunn and colleagues [7] have demonstrated from the Melbourne DIAMOND study, the increased prevalence of depression in a wide range of long term physical conditions in primary care. They found an increased likelihood of depression with increasing multimorbidity which appeared to be mediated by associated functional limitation and self rated health. Guthrie and colleagues [9] suggest integrating relevant single condition guidelines to make them more relevant for managing multimorbidity
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