A qualitative investigation of the impact of multimorbidity on GP diagnosis and treatment of depression in Australia

Stanners, Melinda; Barton, Chris; Shakib, Sepehr; Winefield, Helen R.

doi:10.1080/13607863.2012.702730

Cited by 13 publications

(35 citation statements)

References 21 publications

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“…Few patients were referred to psychotherapeutic interventions, with several stating that they would have appreciated a non-pharmacological intervention. This reflects previous findings in which GPs acknowledged the benefit of psychotherapy for situational depression, and recognized that depression amongst multimorbid patients was sometimes situational, but withheld psychotherapy referral because of doubts about its efficacy in older patients [16]. In light of participants’ situational attribution of depression, GPs should consider recommending psychotherapy where multimorbid patients have experienced functional and social role losses.…”

Section: Discussionsupporting

confidence: 80%

“…Previous studies exploring patient experiences of illness and depression in specific patient groups have identified themes such as the burden of uncertainty amongst gynaecological patients [12] and chronic heart failure patients [13] as contributory to depression, and guilt, perceived stigma, duty to be well, and shame regarding self-regulation of mood amongst depressed adults [14,15], but no research to date has explored the experience of depression onset, diagnosis and treatment in patients with multiple chronic conditions [16]. …”

Section: Introductionmentioning

confidence: 99%

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Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

et al. 2014

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BackgroundWe explored experiences of depression diagnosis and treatment amongst multimorbid patients referred to a metropolitan multidisciplinary outpatient clinic to identify commonalities across this patient group.MethodsPatients with two or more chronic conditions and a diagnosis of depression participated in semi-structured interviews that were digitally recorded and transcribed. Thematic analysis was performed on the transcriptions.ResultsMultimorbid patients attributed depressive symptoms to the loss of ‘normal’ roles and functionality and struggled to reconcile the depression diagnosis with their sense of identity. Beliefs about themselves and depression affected their receptivity to diagnosis and intervention strategies. These included prescribed interventions, such as psychotherapy or pharmacotherapy, and patient-developed strategies.ConclusionsFunctional and social role losses present a clear context in which GPs should raise the subject of mood, with the situational attribution of depression suggesting that psychotherapy, which is rarely offered, should be prioritised in these circumstances.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

et al. 2014

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“…However, multimorbidity also generates relationship through frequent visits and creates time to investigate causation and negotiate the depression diagnosis with the patient. Knowledge of the patient has impact on the intervention (Stanners et al, 2012). It has also been shown by Vyas and Sambamoorthi that competing demands due to multiple chronic conditions do not affect depression treatment.…”

Section: Aging and Mental Health 1025mentioning

confidence: 96%

“…Multimorbidity has also previously been shown to be associated with both frequency and depth of depression . General practitioners (GPs), who were interviewed about the impact of multimorbidity on the diagnosis and detection of depression, described multimorbidity as obscuring symptom causation (Stanners et al, 2012). However, multimorbidity also generates relationship through frequent visits and creates time to investigate causation and negotiate the depression diagnosis with the patient.…”

Section: Aging and Mental Health 1025mentioning

confidence: 99%

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Depressive symptoms among frail elderly in ordinary living: who is affected and who is treated?

Modig

Midlöv

Kristensson

2014

Aging & Mental Health

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Long‐term antidepressant use in a cohort of older people

O’Neill

McFarland

Kelly

2021

Int J Geriat Psychiatry

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Objectives Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use. Methods Adults aged 50 and over, from The Irish Longitudinal Study on Ageing (TILDA), who participated at any one of the four TILDA waves (n = 8175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model‐based approach we used to identify underlying subgroups in a population. Results We found antidepressant use ranged from 6% to 10%, over a 6‐year period. RMLCA identified three distinct classes of antidepressant use. Notably, 6% of older adults were categorised in a ‘long‐term antidepressant use’ class, with consistent use across all four waves, and 6% were categorised in an ‘Intermittent/Developing Use’ class. We found long‐term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services. Conclusions These findings provide evidence of the complex presentations of depression with comorbidities in long‐term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary improve management of this condition.

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A qualitative investigation of the impact of multimorbidity on GP diagnosis and treatment of depression in Australia

Cited by 13 publications

References 21 publications

Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

Depressive symptoms among frail elderly in ordinary living: who is affected and who is treated?

Long‐term antidepressant use in a cohort of older people

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