Institute of Health Informatics, UCL, London, UK
Research Department of Primary Care and Population Health, University College London, London, UK.
BMJ Open. 2022 Feb 24;12(2):e056566. doi: 10.1136/bmjopen-2021-056566.
To understand how the lived experience of depression differs among patients with a long-term condition (LTC) compared with those without an LTC, and how the experience differs across different types of LTC.
Face-to-face, semistructured interviews.
Primary care; General Practitioner (GP) surgeries in and around North London.
41 primary care patients with depression were recruited. Our sample comprised participants aged 55-75 years with depression only (n=12), depression and coronary heart disease (n=5), depression and type 2 diabetes (n=10) and depression and arthritis (n=14).
Interviews were conducted, audio recorded, transcribed and analysed using thematic analysis. The results revealed that the cardinal diagnostic symptoms of depression (anhedonia, sadness) were experienced by all our participants regardless of LTC. However, the LTC did interact with depression by compounding somatic, cognitive and emotional symptoms, increasing disability and reducing independence, and hindering attempts at coping with mental illness. Our findings demonstrate common experiences across patients as well as key differences based on LTC.
We suggest four key implications for future care practices of these patients: (1) not all participants with depression and LTC view their mental and physical health as interconnected; there should be allowances in care plans for separate treatment pathways; (2) key features of depression that affect LTC management are social withdrawal and lack of motivation to self-manage or access healthcare; (3) key features of LTCs that worsen depression are pain, the unpredictability of future health and progressive disability; (4) positive self-management of LTC could improve self-efficacy and therefore mood, and should be encouraged.
了解患有长期疾病 (LTC) 的患者与没有 LTC 的患者的抑郁体验有何不同，以及不同类型的 LTC 之间的体验有何不同。
面对面、半结构化访谈。
初级保健；伦敦北部内外的全科医生 (GP) 诊所。
招募了 41 名患有抑郁症的初级保健患者。我们的样本包括年龄在 55-75 岁之间、仅患有抑郁症的参与者（n=12）、患有抑郁症和冠心病的参与者（n=5）、患有抑郁症和 2 型糖尿病的参与者（n=10）以及患有抑郁症和关节炎的参与者（n=14）。
进行了访谈，使用主题分析对音频记录、转录和分析。结果表明，所有参与者都经历了抑郁症的主要诊断症状（快感缺失、悲伤），无论是否患有 LTC。然而，LTC 通过加重躯体、认知和情绪症状、增加残疾和降低独立性以及阻碍应对精神疾病的尝试，与抑郁症相互作用。我们的研究结果表明，患者之间存在共同的体验，同时也存在基于 LTC 的关键差异。
我们为这些患者的未来护理实践提出了四项关键建议：（1）并非所有患有 LTC 和抑郁症的患者都认为他们的身心健康相互关联；护理计划中应允许单独的治疗途径；（2）影响 LTC 管理的抑郁症的关键特征是社交退缩和缺乏自我管理或获得医疗保健的动力；（3）使 LTC 恶化的抑郁症的关键特征是疼痛、未来健康的不可预测性和进行性残疾；（4）积极管理 LTC 可以提高自我效能感，从而改善情绪，应予以鼓励。
