Abstract
BackgroundDetection of depression can be difficult in primary care, particularly when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. We explored patient beliefs about the nature of depression associated with physical illness.MethodsA qualitative interview study of patients registered with general practices in Leeds, UK. We invited patients with coronary heart disease or diabetes from primary care to participate in semi-structured interviews exploring their beliefs and experiences. We analysed transcripts using a thematic approach, extended to consider narratives as important contextual elements.ResultsWe interviewed 26 patients, including 17 with personal experience of depression. We developed six themes: recognising a problem, complex causality, the role of the primary care, responsibility, resilience, and the role of their life story. Participants did not consistently talk about depression as an illness-like disorder. They described a change in their sense of self against the background of their life stories. Participants were unsure about seeking help from general practitioners (GPs) and felt a personal responsibility to overcome depression themselves. Chronic illness, as opposed to other life pressures, was seen as a justifiable cause of depression.ConclusionsPeople with chronic illness do not necessarily regard depression as an easily defined illness, especially outside of the context of their life stories. Efforts to engage patients with chronic illness in the detection and management of depression may need further tailoring to accommodate beliefs about how people view themselves, responsibility and negative views of treatment.
Highlights
Detection of depression can be difficult in primary care, when associated with chronic illness
We explored patient beliefs about the nature of depression associated with physical illness, especially the degree to which those beliefs conform to ideas about depression as an illness
Semi-structured interview schedule findings were discussed, we perceived a risk that our thematic analysis excluded important contextual information and the relevance of the life story; the analysis was expanded by looking within each transcript for continuity and relevant contextual information
Summary
Detection of depression can be difficult in primary care, when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. We explored patient beliefs about the nature of depression associated with physical illness. Co-morbid depression and chronic physical illness is associated with increased morbidity and mortality [1,2] detection and management rates in primary care are well below stated prevalence’s [3]. Patients with back pain are often reluctant to undertake therapeutic physical activity because of fears about exacerbating underlying structural problems and pain related fears are related to engagement with management and long term disability. S. Preventive Services Task Force encourage screening for depression, but only where there is collaborative care available to ensure structured follow up and management [9,10,11,12]
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