Department of Psychology and Sociology, University of Zaragoza, Violante de Hungria 23, 50009, Zaragoza, Spain.
Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain.
BMC Psychiatry. 2018 Jun 19;18(1):205. doi: 10.1186/s12888-018-1779-7.
Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression.
A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data.
Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'.
The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.
重度抑郁症是一种高发疾病。其发病机制与多种生物和社会心理因素有关，其中包括与生活方式相关的因素。基于生活方式的干预措施似乎是一种合适的辅助治疗策略。本研究旨在探索并确定患者和医疗保健专业人员的期望和经验，这些期望和经验可以指出促进重度抑郁症患者健康饮食和卫生行为的主要障碍和促进因素。
采用定性设计，从初级保健（PC）中广泛选择有目的和理论指导的抑郁患者和卫生专业人员样本。使用深度访谈和小组讨论。设计了一个标准化的方案来指导访谈和小组，包括准备一个主题列表，列出之前测试过的、可能感兴趣的开放性建议。采用扎根理论进行主题分析，以探索、发展和定义个体访谈和小组数据中得出的分析类别的出现，直到达到饱和。
患者和 PC 专业人员都注意到了实施针对抑郁患者获取健康饮食和卫生习惯的方案的一系列核心方面，这些方面可能围绕“个人”、“方案”和“交叉”方面进行组织。就个人方面而言，发现了“患者病史”和“处置”等类别；方案方面包括“介绍和监测”以及“认知”和“行为”习惯的修改等类别；而交叉方面包括“社会支持”的可能性和“目标”类别的定义。
在患有抑郁症的患者中实施结合饮食和卫生相关因素的干预方案是复杂的，这是由于该疾病本身及其症状（如冷漠、内疚或无能感）的性质所致。干预成功的关键问题存在，例如指导方针的简单性、通过动机访谈进行定制、在疾病的不同阶段进行长时间和强烈的监测，以及提供适当的反馈和社会支持。PC 可能是实施这些干预措施的合适层次。
