Patients' and practice nurses' perceptions of depression in patients with type 2 diabetes and/or coronary heart disease screened for subthreshold depression.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

Original Publication: London : BioMed Central, [2000-2021]

Attitude of Health Personnel* ; Attitude to Health* ; Coronary Disease*/epidemiology ; Coronary Disease*/psychology ; Depression*/diagnosis ; Depression*/physiopathology ; Depression*/prevention & control ; Depression*/psychology ; Diabetes Mellitus, Type 2*/epidemiology ; Diabetes Mellitus, Type 2*/psychology ; Quality of Life*; Adult ; Communication Barriers ; Female ; Humans ; Male ; Middle Aged ; Netherlands/epidemiology ; Nurse Practitioners/psychology ; Nurse Practitioners/statistics & numerical data ; Practice Patterns, Nurses' ; Primary Health Care/methods ; Qualitative Research ; Social Stigma

Background: Comorbid depression is common in patients with type 2 diabetes (DM2) and/or coronary heart disease (CHD) and is associated with poor quality of life and adverse health outcomes. However, little is known about patients' and practice nurses' (PNs) perceptions of depression. Tailoring care to these perceptions may affect depression detection and patient engagement with treatment and prevention programs. This study aimed to explore patients' and PNs' perceptions of depression in patients with DM2/CHD screened for subthreshold depression.
Methods: A qualitative study was conducted as part of a Dutch stepped-care prevention project. Using a purposive sampling strategy, data were collected through semi-structured interviews with 15 patients and 9 PNs. After consent, all interviews were recorded, transcribed verbatim and analyzed independently by two researchers with Atlas.ti.5.7.1 software. The patient and PN datasets were inspected for commonalities using a constant comparative method, from which a final thematic framework was generated.
Results: Main themes were: illness perception, need for care and causes of depression. Patients generally considered themselves at least mildly depressed, but perceived severity levels were not always congruent with Patient Health Questionnaire 9 scores at inclusion. Initially recognizing or naming their mental state as a (subthreshold) depression was difficult for some. Having trouble sleeping was frequently experienced as the most burdensome symptom. Most experienced a need for care; psycho-educational advice and talking therapy were preferred. Perceived symptom severity corresponded with perceived need for care, but did not necessarily match help-seeking behaviour. Main named barriers to help-seeking were experienced stigma and lack of awareness of depression and mental health care possibilities. PNs frequently perceived patients as not depressed and with minimal need for specific care except for attention. Participants pointed to a mix of causes of depression, most related to negative life events and circumstances and perceived indirect links with DM2/CHD.
Conclusion: Data of the interviewed patients and PNs suggest that they have different perceptions about (subthreshold) depressive illness and the need for care, although views on its causes seem to overlap more.

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Keywords: Coronary heart disease; Depression; Illness perceptions; Need for care; Qualitative study; Type 2 diabetes mellitus

Date Created: 20181224 Date Completed: 20190919 Latest Revision: 20240413

20240413

PMC6304236

10.1186/s12875-018-0870-y

30579329