Teo Alan R, Marsh Heather E, Ono Sarah S, Nicolaidis Christina, Saha Somnath, Dobscha Steven K
VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA.
Department of Psychiatry, Oregon Health & Science University,, Portland, OR, USA.
J Gen Intern Med. 2020 Jul;35(7):1954-1962. doi: 10.1007/s11606-020-05692-7. Epub 2020 Feb 19.
Social connectedness exerts strong influences on health, including major depression and suicide. A major component of social connectedness is having individual relationships with close supports, romantic partners, and other trusted members of one's social network.
The objective of this study was to understand how individuals' relationships with close supports might be leveraged to improve outcomes for primary care patients with depression and at risk for suicide.
In this qualitative study, we used a semi-structured interview guide to probe patient experiences, views, and preferences related to social support.
We conducted interviews with 30 primary care patients at a Veterans Health Administration (VA) medical center who had symptoms of major depression and a close support.
Thematic analysis of qualitative interview data examined close supports' impact on patients. We iteratively developed a codebook, used output from codes to sort data into themes, and selected quotations that exemplified themes for inclusion in this manuscript.
"Being there" as an important quality of close supports emerged as a key concept. "Being there" was defined in three ways: physical proximity, frequent or responsive contact, or perceived availability. Close supports who were effective at "being there" possessed skills in intuitively sensing the patient's emotional state and communicating indirectly about depression. Three major barriers to involving close supports in depression care were concerns of overburdening the close support, a perception that awareness of the patient's depression would make the close support unnecessarily worried, and a desire and preference among patients to handle depression on their own.
"Being there" represents a novel, patient-generated way to conceptualize and talk about social support. Suicide prevention initiatives such as population-level communication campaigns might be improved by incorporating language used by patients and addressing attitudinal barriers to allowing help and involvement of close supports.
社会联系对健康有重大影响，包括重度抑郁症和自杀。社会联系的一个主要组成部分是与亲密支持者、浪漫伴侣以及社交网络中其他可信赖成员建立个人关系。
本研究的目的是了解如何利用个体与亲密支持者的关系来改善患有抑郁症且有自杀风险的初级保健患者的治疗效果。
在这项定性研究中，我们使用半结构化访谈指南来探究患者与社会支持相关的经历、观点和偏好。
我们对一家退伍军人健康管理局（VA）医疗中心的30名患有重度抑郁症症状且有亲密支持者的初级保健患者进行了访谈。
对定性访谈数据进行主题分析，以考察亲密支持者对患者的影响。我们反复制定编码手册，利用编码结果将数据分类为主题，并挑选出能体现主题的引语纳入本文。
“陪伴左右”作为亲密支持者的一项重要品质成为关键概念。“陪伴左右”有三种定义方式：身体上的亲近、频繁或及时的联系，或感觉随时可及。能有效“陪伴左右”的亲密支持者具备直观感知患者情绪状态并间接谈论抑郁症的技巧。让亲密支持者参与抑郁症护理的三大主要障碍是担心给亲密支持者造成过重负担、认为让亲密支持者知晓患者的抑郁症会使其不必要地担忧，以及患者希望并倾向于自行应对抑郁症。
“陪伴左右”代表了一种由患者提出的新颖方式，用于概念化和谈论社会支持。诸如针对大众的宣传活动等自杀预防举措，或许可以通过纳入患者使用的语言并消除阻碍亲密支持者提供帮助和参与的态度障碍来加以改进。
