Patients' Experience of Depression: What is the nature of

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Patients' Experience of Depression What is the
nature of the concerns patients experience when
they stop their antidepressant medication?

• Presentation for MPhil to PhD Upgrade
• Penny Louch
• 4th December 2006

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Swanton Morley Nurse-led Surgery
Elmham Surgery
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Presentation Plan

• Contextualising depression
• Treatments for depression
• Causes of depression
• Theoretical framework
• Study
• Initial results
• Future plan
• Knowledge transfer

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Global Burden of Depression
WHO. The European Health Report 2002.
2002. Copenhagen, Denmark, WHO Regional Office
for Europe. WHO. World Health Statistics 2006.
2006. France, WHO.
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European Burden of Depression
WHO. The World Health Report 2001. Mental
Health New Understanding, New Hope. Geneva WHO,
2001
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The Burden of Depression

• Personal
• Family
• Social
• Economic
• Increased mortality

• Office for National Statistics. Psychiatric
  Morbidity in Great Britain, 2000, Prevalence of
  Psychiatric Morbidity Among Adults Living in
  Private Households. London HMSO, 2001.
• The Centre for Economic Performance's Mental
  Health Policy Group. The Depression Report New
  Deal for Depression and Anxiety Disorders.
  London
• London School of Economics, 2006.

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The Economic Impact of Depression
Department for Work and Pensions. Individual
Benefit Statistics. May 2004. DWP Resource
Centre.
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Antidepressant Prescriptions Costs
Dept.Health. Prescription Cost Analysis England
1998-2005. London Department of Health, 2000-2006
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A Cost Matrix of Depression
Chisholm D. The economic consequences of
depression. In Dawson A, Tylee A, eds.
Depression Social and economic timebomb, pp
121-9. London BMJ Publishing Group, 2001The
Sainsbury Centre For Mental Health. The economic
and social costs of mental illness Policy Paper
3. 2003. London, The Sainsbury Centre For Mental
Health
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Causes of Depression
WHO. The World Health Report 2001. Mental
Health New Understanding, New Hope. Geneva
WHO, 2001.
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(No Transcript)
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Depression Diagnosis in Primary Care
Rule of Halves
Lepine JP, Gastpar M, Mendlewicz J, Tylee A.
Depression in the community The first
pan-European study DEPRES (Depression Research in
European Society). Int.Clin.Psychopharmacol.
19971219-29.
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Research Questions

• What is the nature of the concerns patients
  experience when they stop their antidepressant
  medication? and Are these concerns dependent
  upon a personal construction of the meaning of
  recovery from a depressive illness?

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Objectives

• To understand model(s) of recovery
• To inform healthcare professionals
• To develop an appropriate counselling strategy(s)
  
• To help reduce relapse rates

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Theoretical Framework
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Explanatory Model Theory

• Illness v. disease
• Patient clinician explanatory models
• 5 parts of an illness experience

Kleinman A. Patients and healers in the context
of culture. Berkeley, CA University of
California Press, 1980.
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Study Design

• General practice
• Mixed method approach
• Questionnaires

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Early Themes

• The meaning of depression
• The dilemma of medication
• Hopes and fears
• Locus of control
• Loss
• Depression illness trajectory

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Study Design

• Interviews

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Interviews
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Data Analysis

• Framework

Ritchie J, Spencer L. Qualitative data analysis
for applied policy research. In Bryman A, Burgess
RG, eds. Analysing Qualitative Data, pp 173-94.
London Routledge, 1994.
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Timeline
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Knowledge Transfer
www.depression-primarycare.co.uk
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Thank you