Burroughs Heather, Lovell Karina, Morley Mike, Baldwin Robert, Burns Alistair, Chew-Graham Carolyn
Division of Primary Care, University of Manchester, Rusholme Academic Unit, Rusholme, Manchester M14 5NP, UK.
Fam Pract. 2006 Jun;23(3):369-77. doi: 10.1093/fampra/cmi115. Epub 2006 Feb 13.
Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated.
To explore the ways that primary care professionals and patients view the causes and management of late-life depression.
A qualitative study using semistructured interviews.
One Primary Care Trust in North West England.
Fifteen primary care practitioners comprising nine GPs, three practice nurses, two district nurses and one community nurse; twenty patients who were over the age of 60 and who were participating in a feasibility study of a new model of care for late-life depression [PRIDE Trial: PRimary care Intervention for Depression in the Elderly (a feasibility study in Central Manchester funded by the Department of Health)].
Primary care practitioners conceptualized late-life depression as a problem of their everyday work, rather than as an objective diagnostic category. They described depression as part of a spectrum including loneliness, lack of social network, reduction in function and viewed depression as 'understandable' and 'justifiable'. This view was shared by patients. Therapeutic nihilism, the feeling that nothing could be done for this group of patients, was a feature of all primary care professionals' interviews. Patients' views were characterized by passivity and limited expectations of treatment. Depression was not viewed as a legitimate illness to be taken to the GP. Primary care professionals recognized that managing late-life depression did fall within their remit, but identified limitations in their own skills and capabilities in this area, as well as a lack of other resources to which they could refer patients.
This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.
抑郁症是老年人中最常见的心理健康问题，目前仍未得到充分诊断和治疗。
探讨基层医疗专业人员和患者对老年期抑郁症病因及治疗的看法。
采用半结构式访谈的定性研究。
英格兰西北部的一个基层医疗信托机构。
15名基层医疗从业者，包括9名全科医生、3名执业护士、2名社区护士和1名地区护士；20名60岁以上的患者，他们参与了一项针对老年期抑郁症新型护理模式的可行性研究[PRIDE试验：老年人抑郁症的基层医疗干预（由卫生部资助的曼彻斯特市中心可行性研究）]。
基层医疗从业者将老年期抑郁症视为日常工作中的一个问题，而非一个客观的诊断类别。他们将抑郁症描述为包括孤独、缺乏社交网络、功能减退在内的一系列问题的一部分，并认为抑郁症是“可以理解的”和“合理的”。患者也持有这种观点。治疗虚无主义，即认为对这类患者无能为力的感觉，是所有基层医疗专业人员访谈中的一个特点。患者的观点表现为被动和对治疗的期望有限。抑郁症不被视为一种值得去看全科医生的合理疾病。基层医疗专业人员认识到管理老年期抑郁症确实属于他们的职责范围，但指出了他们在这方面自身技能和能力的局限性，以及缺乏可供患者转诊的其他资源。
本研究凸显了老年期抑郁症诊断和管理的复杂性。抑郁症的诊断和治疗方案强调生物医学模式，这与全科医生的日常经验或老年患者不符，这些患者与基层医疗专业人员有相同的观点，即抑郁症是社会和环境问题的结果。在基层医疗中，需要为患有抑郁症的老年人制定基于证据的服务，但也需要让老年患者意识到向基层医疗专业人员诉说情绪低落和痛苦的合理性。
