Family Practice Advance Access originally published online on July 13, 2007
Family Practice 2007 24(4):358-364; doi:10.1093/fampra/cmm032
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How patients with depressive symptoms view their condition: a qualitative study
a Centre for Integrated Health Care Research, University of Durham, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, TS17 6BH, UK
b Newlands Medical Centre, Borough Road, Middlesbrough, TS1 3RX, UK
Correspondence to: Charles S. Cornford, Centre for Integrated Health Care Research, University of Durham, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, TS17 6BH, UK; Email: charles.cornford{at}durham.ac.uk
Received 23 June 2006; Revised 15 May 2007; Accepted 29 May 2007.
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Abstract |
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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.
Keywords. Attitude to health, depression, primary care.
Cornford CS, Hill A, Reilly J. How patients with depressive symptoms view their condition: a qualitative study. Family Practice 2007; 24: 358–364.
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