Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

Abstract

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.

Patients’ experiences of coping with multiple chronic conditions: A meta‐ethnography of qualitative work

“…; Stanners et al . ). Some negotiated life changes by lowering their life expectations (Löffler et al .…”

Meta-analysis of the effects of sleep deprivation on depression in patients and animals

“…However, light therapy alone was not as effective as SD [30]. As for medication alone, the effects are slow to manifest, and side effects may cause patients to change medication or refuse it altogether [7, 8]. For these reasons, many researchers have tried combining antidepressants with sleep deprivation, BLT, or CBT to form integrated antidepressant treatments, which have been shown to have positive effects [31, 32].…”

“…Since relapse rates for depressive disorder are high, various potentially negative long-term outcomes are associated with it, including difficulties with interpersonal relationships, efficacy, tolerability and acceptability of antidepressants [5, 6]. Most people with depression have tried at least one antidepressant medication, although medication effects are slow to manifest, and side effects such as insomnia and anxiety lead patients to try different medications or refuse medication altogether [7, 8]. Furthermore, 30%–40% of patients are resistant to available antidepressant medications commonly prescribed for the major depressive disorder [9].…”

Mood Disorders in Middle-Aged and Older Veterans With Multimorbidity

“…Unfortunately, chronic health conditions rarely occur in isolation but rather in combination with mental health conditions, such as mood disorders (Katon, 2011; Meghani et al, 2013). In the general population, irrespective of age, gender, or specific disease, the risk of depression and/or anxiety increases with each chronic health condition acquired (Gunn et al, 2012; Stanners, Barton, Shakib, & Winefield, 2014). Similarly, primary care patients with depression compared with those without depression are more likely to have multimorbidity (2.65 greater odds of having five or more physical health conditions; Smith et al, 2014).…”