Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500 Krems a.d, Donau, Austria.
BMC Psychiatry. 2018 Nov 26;18(1):372. doi: 10.1186/s12888-018-1951-0.
Seasonal affective disorder (SAD) is a seasonally recurrent type of major depression that has detrimental effects on patients' lives during winter. Little is known about how it affects patients during summer and about patients' and physicians' perspectives on preventive SAD treatment. The aim of our study was to explore how SAD patients experience summers, what type of preventive treatment patients implement, which preventive treatment methods, if any, physicians recommend, and what factors facilitate or hinder implementation/recommendation of SAD prevention.
We conducted 15 semi-structured interviews, ten with adult patients with a history of SAD and five with physicians. Transcripts were analyzed by two researchers using an inductive thematic analysis approach.
One group of patients was able to enjoy summer and ignore thoughts of the upcoming winter. The other group feared the impending depressive episode in winter, and this fear negatively impacted these patients' well-being during the summer. Preventive treatment was a relevant issue for all patients, and all but one person implemented SAD prevention during summer. We identified six factors that influenced patient use of preventive treatment of SAD. Four factors occur on an individual level (knowledge about disease and preventive treatment options, experience with treatment in acute phase, acceptability of intervention, willingness to take responsibility for oneself), one on an interpersonal level (social and work environment), and one on a structural level (healthcare system). All psychiatrists recommended some kind of preventive intervention, most commonly, lifestyle changes. Four factors influenced psychiatrists in recommending prevention of SAD (patient expectations, disease history and stability, risk/benefit ratio, lack of evidence).
Success in the implementation of SAD prevention does not solely depend on the willingness of the patients, but is also influenced by external factors. Raising awareness of SAD among general practitioners and low-level access to mental-health support could help patients find appropriate help sooner. To better guide the optimal treatment choice, comparative effectiveness research on treatments to prevent a new onset in patients with a history of SAD and clinical practice guidelines on SAD are needed.
季节性情感障碍（SAD）是一种季节性复发性重度抑郁症，在冬季会对患者的生活产生不利影响。目前对于 SAD 在夏季如何影响患者以及患者和医生对预防性 SAD 治疗的看法知之甚少。我们的研究目的是探讨 SAD 患者如何度过夏季，患者实施何种预防性治疗，医生推荐何种预防性治疗方法，如果有的话，以及哪些因素促进或阻碍 SAD 预防的实施/推荐。
我们进行了 15 次半结构化访谈，10 次与有 SAD 病史的成年患者进行，5 次与医生进行。两位研究人员使用归纳主题分析方法对转录本进行分析。
一组患者能够享受夏季，忽略即将到来的冬季的想法。另一组则担心即将到来的冬季抑郁发作，这种恐惧对他们夏季的健康产生负面影响。预防性治疗是所有患者的一个相关问题，除了一个人之外，所有人都在夏季实施了 SAD 预防。我们确定了影响患者使用 SAD 预防性治疗的六个因素。其中四个因素发生在个体层面（对疾病和预防性治疗选择的了解、治疗急性期的经验、干预的可接受性、对自己负责的意愿），一个因素发生在人际层面（社会和工作环境），一个因素发生在结构层面（医疗保健系统）。所有精神科医生都建议某种预防性干预措施，最常见的是生活方式的改变。四个因素影响了精神科医生推荐预防 SAD（患者的期望、病史和稳定性、风险/效益比、缺乏证据）。
SAD 预防的实施成功不仅取决于患者的意愿，还受到外部因素的影响。提高全科医生对 SAD 的认识和获得心理健康支持的低层次途径可以帮助患者更快地找到适当的帮助。为了更好地指导最佳治疗选择，需要对有 SAD 病史的患者进行新发病例预防治疗的比较效果研究，并制定 SAD 的临床实践指南。
