Murray Joanna, Banerjee Sube, Byng Richard, Tylee Andre, Bhugra Dinesh, Macdonald Alastair
Health Services Research Department, Institute of Psychiatry, King's College, London, UK.
Soc Sci Med. 2006 Sep;63(5):1363-73. doi: 10.1016/j.socscimed.2006.03.037. Epub 2006 May 15.
An understanding of patients' perspectives is crucial to improving engagement with health care services. For older people who may not wish to bother medical professionals with problems of living such as depression, such exploration becomes critical. General practitioners (GPs), nurses and counsellors working in 18 South London primary care teams were interviewed about their perceptions of depression in older people. All three professional groups shared a predominantly psychosocial model of the causes of depression. While presentation of somatic symptoms was seen as common in all age groups, identification of depression in older patients was complicated by co-existent physical illnesses. GPs reported that older patients rarely mentioned psychological difficulties, but practice nurses felt that older people were less inhibited in talking to them about "non-medical" problems. Many older people were perceived to regard symptoms of depression as a normal consequence of ageing and not to think it appropriate to mention non-physical problems in a medical consultation. Men were thought to be particularly reluctant to disclose emotional distress and were more vulnerable to severe depression and suicide. Some GPs had mixed feelings about offering medication to address what they believed to be the consequences of loneliness and social isolation. Participants thought that many older people regard depression as a "sign of weakness" and the perceived stigma of mental illness was widely recognised as a barrier to seeking help. Cultural variations in illness beliefs, especially the attribution of symptoms, were thought to profoundly influence the help-seeking behaviour of elders from minority ethnic groups. Families were identified as the main source of both support and distress; and as such their influence could be crucial to the identification and treatment of depression in older people.
了解患者的观点对于提高他们与医疗服务的参与度至关重要。对于那些可能不想因诸如抑郁症等生活问题而麻烦医疗专业人员的老年人来说，这种探索变得至关重要。对在伦敦南部18个初级保健团队工作的全科医生（GP）、护士和顾问进行了访谈，询问他们对老年人抑郁症的看法。所有这三个专业群体都主要认同抑郁症病因的社会心理模型。虽然躯体症状在所有年龄组中都很常见，但老年患者抑郁症的识别因并存的身体疾病而变得复杂。全科医生报告说，老年患者很少提及心理困难，但实习护士认为老年人在与他们谈论“非医疗”问题时不那么拘谨。许多老年人被认为将抑郁症症状视为衰老的正常后果，并且认为在医疗咨询中提及非身体问题不合适。男性被认为特别不愿意透露情绪困扰，更容易患严重抑郁症和自杀。一些全科医生对于提供药物来解决他们认为是孤独和社会隔离后果的问题持复杂态度。参与者认为许多老年人将抑郁症视为“软弱的表现”，并且精神疾病的污名化被广泛认为是寻求帮助的障碍。疾病观念的文化差异，尤其是症状的归因，被认为会深刻影响少数族裔老年人的求助行为。家庭被认为是支持和困扰的主要来源；因此，他们的影响对于识别和治疗老年人的抑郁症可能至关重要。
