Service User Research Enterprise (SURE), Institute of Psychiatry, King's College London, London, UK.
BMC Fam Pract. 2013 Mar 19;14:38. doi: 10.1186/1471-2296-14-38.
The prevalence of depression in people with coronary heart disease (CHD) is high but little is known about patients' own perceptions and experiences of this. This study aimed to explore (i) primary care (PC) patients' perceptions of links between their physical condition and mental health, (ii) their experiences of living with depression and CHD and (iii) their own self-help strategies and attitudes to current PC interventions for depression.
Qualitative study using consecutive sampling, in-depth interviews and thematic analysis using a process of constant comparison. 30 participants from the UPBEAT-UK cohort study, with CHD and symptoms of depression. All participants were registered on the General Practitioner (GP) primary care, coronary register.
A personal and social story of loss underpinned participants' accounts of their lives, both before and after their experience of having CHD. This theme included two interrelated domains: interpersonal loss and loss centred upon health/control issues. Strong links were made between CHD and depression by men who felt emasculated by CHD. Weaker links were made by participants who had experienced distressing life events such as divorce and bereavement or were living with additional chronic health conditions (i.e. multimorbidity). Participants also felt 'depressed' by the 'medicalisation' of their lives, loneliness and the experience of ageing and ill health. Just under half the sample had consulted their GP about their low mood and participants were somewhat ambivalent about accessing primary care interventions for depression believing the GP would not be able to help them with complex health and social issues. Talking therapies and interventions providing the opportunity for social interaction, support and exercise, such as Cardiac Rehabilitation, were thought to be helpful whereas anti-depressants were not favoured.
The experiences and needs of patients with CHD and depression are diverse and include psycho-social issues involving interpersonal and health/control losses. In view of the varying social and health needs of patients with CHD and depression the adoption of a holistic, case management approach to care is recommended together with personalised support providing the opportunity for patients to develop and achieve life and health goals, where appropriate.
冠心病（CHD）患者的抑郁患病率较高，但人们对患者自身对这种疾病的认知和体验知之甚少。本研究旨在探讨：（i）初级保健（PC）患者对其身体状况和心理健康之间关系的看法；（ii）他们患有抑郁症和 CHD 的生活体验；（iii）他们自身的自助策略以及对当前 PC 抑郁干预措施的态度。
采用连续抽样、深入访谈和主题分析的定性研究方法，采用恒定性比较的过程。参与者为 UPBEAT-UK 队列研究中的 30 名患者，患有 CHD 和抑郁症状。所有参与者均在注册全科医生（GP）初级保健、冠心病登记处登记。
个人和社会的失落故事构成了参与者对生活的描述，包括在经历 CHD 之前和之后。这一主题包括两个相互关联的领域：人际关系的丧失和以健康/控制问题为中心的丧失。一些男性认为 CHD 使他们失去男子气概，因此他们将 CHD 和抑郁紧密联系在一起。而那些经历过离婚、丧偶或患有其他慢性健康问题（即多病共存）的参与者则联系较弱。参与者还因生活的“医学化”、孤独以及衰老和健康不良的经历而感到“抑郁”。在样本中，近一半的人曾就自己的情绪低落咨询过他们的全科医生，而参与者对获得针对抑郁的初级保健干预措施有些矛盾，他们认为全科医生无法帮助他们解决复杂的健康和社会问题。心理治疗和提供社交互动、支持和锻炼机会的干预措施，如心脏康复，被认为是有帮助的，而抗抑郁药则不受欢迎。
患有 CHD 和抑郁症的患者的经历和需求多种多样，包括涉及人际关系和健康/控制丧失的心理社会问题。鉴于患有 CHD 和抑郁症的患者的社会和健康需求各异，建议采用整体、病例管理的护理方法，并提供个性化的支持，为患者提供机会，在适当的情况下制定和实现生活和健康目标。
