Abstract
BackgroundOlder people can struggle with revealing their depression to GPs and verbalising preferences regarding its management. This contributes to problems for GPs in both detecting and managing depression in primary care. The aim of this study was to explore older people’s accounts of how they talk about depression and possible symptoms to improve communication about depression when seeing GPs.MethodsAdopting a qualitative Interpretivist methodological approach, semi-structured interviews were conducted by IG based on the principles of grounded theory and situational analysis. GPs working in north east England recruited patients aged over 65 with depression. Data analysis was carried out with a process of constant comparison, and categories were developed via open and axial coding and situational maps. There were three levels of analysis; the first developed open codes which informed the second level of analysis where the typology was developed from axial codes. The typology derived from second level analysis only is presented here as older people’s views are rarely reported in isolation.ResultsFrom the sixteen interviews with older people, it was evident that there were differences in how they understood and accepted their depression and that this influenced what they shared or withheld in their narratives. A typology showing three categories of older people was identified: those who appeared to talk about their depression freely yet struggled to accept aspects of it (Superficial Accepter), those who consolidated their ideas about depression aloud (Striving to Understand) and those who shared minimal detail about their depression and viewed it as part of them rather than a treatable condition (Unable to Articulate). The central finding was that older people’s acceptance and understanding of their depression guided their depression narratives.ConclusionsThis study identified differences between older people in ways they understand, accept and share their depression. Recognising that their depression narratives can change and listening for patterns in what older people share or withhold may help GPs in facilitating communication to better understand the patient when they need to implement alternative approaches to patient management.
Highlights
Older people can struggle with revealing their depression to General Practitioner (GP) and verbalising preferences regarding its management
This reluctance conflicts with the value placed on older people talking to GPs about depression whether it is expressing it in terms of situational factors such as loneliness and isolation [12, 13] negotiating how it could be framed as an acceptable concept [11] or establishing justifications for their low mood [10]
This study offers a framework to support GPs in understanding the complexities of the narratives older people may bring to consultations which tend to focus on their life story [10]
Summary
Older people can struggle with revealing their depression to GPs and verbalising preferences regarding its management. Even though older people respond well to probing about their mood by primary care physicians [15] they struggle to reveal depression to GPs [9, 16] or to verbalise their views and preferences relating to the management of their depression [17, 18] This reluctance conflicts with the value placed on older people talking to GPs about depression whether it is expressing it in terms of situational factors such as loneliness and isolation [12, 13] negotiating how it could be framed as an acceptable concept [11] or establishing justifications for their low mood [10]
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