Background: International interest in the informal carer role has grown in part because of the

This study is concerned with the impact of chronic depression on partners. Thirteen male and female participants who lived with a partner with chronic depression were interviewed. Data were analysed using thematic analysis. Findings highlighted a need for caregivers to be more centrally involved in their partner's care, given that they face stigma, shifts in role identity and uncertainty which all potentially threaten the level of support they can give their partner. In this sense depression might be described as a "couples disease" suggesting that couples therapy and group support for partners should be more widely available to help reduce the burden on partners and potentially prevent relationship breakdown.Symptoms of "depression" overlap with a number of diagnostic categories and therefore currently fall within a more generic category of "common mental disorders" (CMD) for the purposes of the UK Adult Psychiatric Morbidity Survey (APMS; Stansfeld et al, 2014). The 2014 APMS found that one in six adults were currently experiencing a CMD.While the majority of these fell into a generic "not otherwise specified" CMD category, a large proportion of these will have been experiencing some symptoms of depression along with other symptoms from the CMD family of diagnoses (anxiety, panic disorder, phobias, obsessive compulsive disorder). The APMS found that 3.3% of adults met diagnostic criteria for depression. Over a third of those scoring for CMD had never had a professional psychiatric diagnosis; and yet two thirds believed they had had depression at some point.These data indicate that while "depression" and depressive symptoms are common and also commonly used as a label by adults experiencing a range of CMD symptoms, many people are living in the community with undiagnosed depression or depressive symptoms and without professional help.Depression poses a significant burden on individuals, their families (Loukissa, 1995) and the state in terms of health and social care costs and thus the benefits of treating depression effectively are widely recognised. UK national guidelines for depression management (2009) produced by the National Institute for Health and Care Excellence (NICE) recommend cognitive behavioral therapies (CBT), behavioral activation, interpersonal therapy, problem-solving therapy, counselling, short-term psychodynamic psychotherapy and couples therapy as well as some pharmacological treatments for depression. The systematic review underpinning these guidelines presents the cost and clinical effectiveness evidence on which these recommendations are based, following the LIVING WITH A PARTNER WITH CHRONIC DEPRESSION prevailing paradigm of evidence based practice in which Randomised Controlled Trial (RCT) designs are ranked more highly than others. This process of evidence review and guideline development was used as the basis for a successful economic policy case (Layard, 2007) for increased provision of psychological therapies in the UK (now known as "Increasing Access to Psychological Therapies...

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