Experiences of treatment decision making for young people diagnosed with depressive disorders: a qualitative study in primary care and specialist mental health settings

Abstract

BackgroundClinical guidelines advocate for the inclusion of young people experiencing depression as well as their caregivers in making decisions about their treatment. Little is known, however, about the degree to which these groups are involved, and whether they want to be. This study sought to explore the experiences and desires of young people and their caregivers in relation to being involved in treatment decision making for depressive disorders.MethodsSemi-structured interviews were carried out with ten young people and five caregivers from one primary care and one specialist mental health service about their experiences and beliefs about treatment decision making. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis.ResultsExperiences of involvement for clients varied and were influenced by clients themselves, clinicians and service settings. For caregivers, experiences of involvement were more homogenous. Desire for involvement varied across clients, and within clients over time; however, most clients wanted to be involved at least some of the time. Both clients and caregivers identified barriers to involvement.ConclusionsThis study supports clinical guidelines that advocate for young people diagnosed with depressive disorders to be involved in treatment decision making. In order to maximise engagement, involvement in treatment decision making should be offered to all clients. Involvement should be negotiated explicitly and repeatedly, as desire for involvement may change over time. Caregiver involvement should be negotiated on an individual basis; however, all caregivers should be supported with information about mental disorders and treatment options.

Making decisions about treatment for young people diagnosed with depressive disorders: a qualitative study of clinicians’ experiences

“…When it came to defining this involvement, clinicians focused on aspects of the client-clinician relationship such as engagement, and having the client feel comfortable enough to explicitly decline treatment options. In previously reported work, clients also felt that relationship-related factors such as engagement and trust were critical [25]. Taken together, these responses support the notion that involvement should be considered not only as specific actions (e.g.…”

Suicide and depression literacy among health professions students in tertiary care centre in South India.

“…Mental health literacy includes a set of interconnected components which are; the ability to recognize disorders in order to facilitate help seeking, knowledge of professional help and treatments available, knowledge of effective selfhelp strategies, knowledge and skills to give first aid and support to others, and knowledge of how to prevent mental disorders (4). Mental health literacy is inadequate both among public and medical healthcare professionals.…”

Key issues in the process of implementing shared decision making (DM) in mental health practice

“…However, carers reported low levels of involvement including being restricted to practical tasks and not being involved in treatment decisions (Morant et al, 2015;Simmons et al, 2011) implicating an untapped resource in the implementation of SDM.…”

“…However, studies demonstrated that this was not occurring consistently. Inpatient settings, in particular, found such sharing difficult to enact (De las Cuevas et al, 2013;Simmons et al, 2011). Service users reported not being informed of diagnoses, there were consistencies in the type of information being shared and a documented lack of choice offered by professionals (Simmons et al, 2010;Smebye et al, 2012).…”