Nuffield Department of Primary Health Care Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.
Faculty of Health and Education, Manchester Metropolitan University, Brooks Building, 53 Bonsall St, Hulme, Manchester, M15 6GX, UK.
BMC Prim Care. 2022 Aug 16;23(1):207. doi: 10.1186/s12875-022-01819-3.
Most adults fail to achieve remission from common mental health conditions based on pharmacological treatment in primary care alone. There is no data synthesising the reasons. This review addresses this gap through a systematic review and thematic synthesis to understand adults' experiences using primary care for treatment-resistant mental health conditions (TRMHCs). We use the results to produce patient-driven recommendations for better support in primary care.
Eight databases were searched from inception to December 2020 for qualitative studies reporting research on people's experience with TRMHCs in primary care. We included the following common mental health conditions defined by NICE: anxiety, depression, panic disorder, post-traumatic stress, and obsessive-compulsive disorder. Two reviewers independently screened studies. Eligible studies were analysed using an aggregative thematic synthesis.
Eleven studies of 4456 were eligible. From these eleven studies, 4 descriptive themes were developed to describe a cycle of care that people with TRMHCs experienced in primary care. In the first stage, people preferred to self-manage their mental health and reported barriers that prevented them from seeing a GP (e.g., stigma). People felt it necessary to see their GP only when reaching a crisis point. In the second stage, people were usually prescribed antidepressants, but were sceptical about any benefits they had to their mental health. In the third stage, people self-managed their mental health (e.g., by adjusting antidepressant dosage). The fourth stage described the reoccurrence of mental health and need to see a GP again. The high-order theme, 'breaking the cycle,' described how this cycle could be broken (e.g., continuity of care).
People with TRMHCs and GPs could break the cycle of care by having a conversation about what to do when antidepressants fail to work. This conversation could include replacing antidepressants with psychological interventions like talking therapy or mindfulness.
大多数成年人在初级保健中仅依靠药物治疗无法摆脱常见的心理健康问题。目前还没有数据综合分析其原因。本研究通过系统综述和主题综合来了解成年人在初级保健中治疗抵抗性心理健康问题（TRMHC）的经验，以解决这一差距。我们使用这些结果为初级保健中提供更好的支持提出患者驱动的建议。
从成立到 2020 年 12 月，我们在八个数据库中搜索定性研究，这些研究报告了人们在初级保健中治疗抵抗性心理健康问题的经验。我们包括 NICE 定义的以下常见心理健康状况：焦虑、抑郁、恐慌症、创伤后应激障碍和强迫症。两位审查员独立筛选研究。使用聚合主题综合分析对合格研究进行分析。
11 项研究（共 4456 项）符合条件。从这 11 项研究中，我们开发了 4 个描述性主题，以描述患有 TRMHC 的人在初级保健中经历的护理周期。在第一阶段，人们更愿意自我管理自己的心理健康，同时报告了一些阻碍他们看全科医生的障碍（例如，耻辱感）。只有当他们达到危机点时，他们才觉得有必要去看全科医生。在第二阶段，人们通常会被开抗抑郁药，但对药物对他们的心理健康有何好处持怀疑态度。在第三阶段，人们自我管理自己的心理健康（例如，调整抗抑郁药剂量）。第四阶段描述了心理健康的再次出现和再次需要看全科医生的情况。高级主题“打破循环”描述了如何打破这种循环（例如，连续性护理）。
患有 TRMHC 的人和全科医生可以通过讨论当抗抑郁药不起作用时该怎么办来打破这种护理周期。这种对话可以包括用谈话疗法或正念等心理干预措施代替抗抑郁药。
