Section of Primary Care Mental Health, Health Services and Population Research Department, PO Box 28, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
BMC Fam Pract. 2012 Jan 5;13:1. doi: 10.1186/1471-2296-13-1.
Depression is common in coronary heart disease (CHD). Affected patients have an increased incidence of coronary symptoms and death. Little is known about how best to manage primary care patients with both CHD and depression. This study is part of the UPBEAT-UK programme of research and was designed to understand general practitioners' (GPs) and practice nurses' (PNs) views and experience of managing depression in CHD.
Individual in-depth interviews with 10 GPs and 12 PNs in South East London. Data were analysed using constant comparison.
GPs and PNs had similar views. Distress following diagnosis or a cardiac event was considered to resolve spontaneously; if it endured or became severe it was treated as depression. GPs and PNs felt that psychosocial problems contributed to depression in patients with CHD. However, uncertainty was expressed as to their perceived role and responsibility in addressing these. In this respect, depression in patients with CHD was considered similar to depression in other patients and no coherent management approach specific for depression in CHD was identified. An individualised approach was favoured, but clinicians were unsure how to achieve this in the face of conflicting patient preferences and the treatment options they considered available.
GPs and PNs view depression in CHD similarly to depression uncomplicated by physical illness. However, uncertainty exists as to how best to manage depression associated psychosocial issues. Personalised interventions are needed which account for individual need and which enable and encourage clinicians and patients to make use of existing resources to address the psychosocial factors which contribute to depression.
抑郁症在冠心病（CHD）中很常见。受影响的患者冠心病症状和死亡的发生率增加。对于如何最好地管理同时患有 CHD 和抑郁症的初级保健患者，知之甚少。这项研究是 UPBEAT-UK 研究计划的一部分，旨在了解全科医生（GP）和执业护士（PN）管理 CHD 中抑郁症的观点和经验。
对伦敦东南部的 10 名全科医生和 12 名执业护士进行了单独的深入访谈。使用恒定性比较法分析数据。
全科医生和执业护士的观点相似。诊断或心脏事件后出现的困扰被认为会自行缓解；如果持续存在或变得严重，则将其视为抑郁症。全科医生和执业护士认为，心理社会问题导致 CHD 患者抑郁。但是，他们对自己在解决这些问题方面的角色和责任表示不确定。在这方面，CHD 患者的抑郁症被认为与其他患者的抑郁症相似，并且没有确定针对 CHD 中抑郁症的一致管理方法。他们赞成采用个性化方法，但临床医生不确定如何在面对患者偏好和他们认为可用的治疗选择存在冲突的情况下实现这一目标。
全科医生和执业护士将 CHD 中的抑郁症与没有躯体疾病的抑郁症视为相似。然而，对于如何最好地管理与抑郁症相关的心理社会问题存在不确定性。需要个性化干预措施，这些措施要考虑到个人需求，并使临床医生和患者能够利用现有资源来解决导致抑郁症的心理社会因素。
