Understandings of depression associated with chronic physical illness – a q-methodology study

Background

Detection of depression can be difficult in primary care, particularly when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. Q-methodology can help to identify viewpoints that are likely to influence either clinical practice or policy intervention.

Aim

To identify socially shared viewpoints of co-morbid depression, and characterise key overlaps and discrepancies.

Design and setting

A Q-methodology study of patients registered with general practices or community clinics in Leeds, UK.

Method

We invited patients with coronary heart disease or diabetes and depression from three practices and community clinics. In a Q-sorting exercise participants ranked 57 statements about co-morbid depression. We undertook factor analyses to identify independent accounts, and drew upon additional interview data to support interpretation.

Results

Thirty-one patients took part; 13 (42%) had current depression symptoms. Five accounts towards co-morbid depression were identified: overwhelmed resources; something medical or within me; a shameful weakness; part of who I am; and recovery-orientated. The main differences in attitudes related to the cause of depression and its relationship with their chronic illness, experience of shame and whether medical interventions would help recovery.

Conclusion

There are groups of patients who do not see a relationship between their depression and chronic illness; they may not understand the intention behind policy initiatives to identify depression during chronic illness reviews. Tailoring detection strategies for depression to take account of different clusters of attitudes and beliefs could help improve identification and personalise management.