Patients’ perceptions of depression and coronary heart disease: a qualitative UPBEAT-UK study

Abstract

BackgroundThe prevalence of depression in people with coronary heart disease (CHD) is high but little is known about patients’ own perceptions and experiences of this. This study aimed to explore (i) primary care (PC) patients’ perceptions of links between their physical condition and mental health, (ii) their experiences of living with depression and CHD and (iii) their own self-help strategies and attitudes to current PC interventions for depression.MethodQualitative study using consecutive sampling, in-depth interviews and thematic analysis using a process of constant comparison. 30 participants from the UPBEAT-UK cohort study, with CHD and symptoms of depression. All participants were registered on the General Practitioner (GP) primary care, coronary register.ResultsA personal and social story of loss underpinned participants’ accounts of their lives, both before and after their experience of having CHD. This theme included two interrelated domains: interpersonal loss and loss centred upon health/control issues. Strong links were made between CHD and depression by men who felt emasculated by CHD. Weaker links were made by participants who had experienced distressing life events such as divorce and bereavement or were living with additional chronic health conditions (i.e. multimorbidity). Participants also felt ‘depressed’ by the ‘medicalisation’ of their lives, loneliness and the experience of ageing and ill health. Just under half the sample had consulted their GP about their low mood and participants were somewhat ambivalent about accessing primary care interventions for depression believing the GP would not be able to help them with complex health and social issues. Talking therapies and interventions providing the opportunity for social interaction, support and exercise, such as Cardiac Rehabilitation, were thought to be helpful whereas anti-depressants were not favoured.ConclusionsThe experiences and needs of patients with CHD and depression are diverse and include psycho-social issues involving interpersonal and health/control losses. In view of the varying social and health needs of patients with CHD and depression the adoption of a holistic, case management approach to care is recommended together with personalised support providing the opportunity for patients to develop and achieve life and health goals, where appropriate.

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

“…The main findings from this study have been published in an open access journal paper by Simmonds et al 85 The interviews were conducted using a narrative approach guided by topics informed by findings from the pilot interview study.…”

“…Losses included interpersonal and health factors. 85 In relation to health, participants experienced a sense of loss that also impacted on feelings of agency and being in control of their lives. Loss of good health through CHD had impacted on employment status and financial security for some participants.…”

The Impact Of Psychological Characteristics On The Effectiveness Of Motivational Interviewing Based Psychological Counseling

“…Approximately, 15-23% heart patients are in deep depression, while only 4.6% of the people have depression in all population (Simmonds et al, 2013). Moreover, there are findings that depression and anxiety symptoms could be found in 40-60% heart patients.…”

Using a patient-generated mental-health measure ‘PSYCHLOPS’ to explore problems in patients with coronary heart disease

“…9 In a further UK survey of 30 patients with CHD and depression, a strong link was established between depression and reduced functional capacity (especially loss of the 'breadwinner' role); links were also identified with multimorbidity and problems of a social nature such as loneliness and relationship concerns. 10 Another means of obtaining qualitative data that are more applicable to larger groups is to use a validated patientgenerated instrument (PGI); these instruments are increasingly used to obtain the patient's perspective and to define outcomes that are of importance to them. One form of PGI, Patient Reported Outcome Measures (PROMS), is currently used in a national survey of certain postoperative patients in the UK; 137 000 PROMS were returned in the year 2011-2012.…”

“…15 Based on previous qualitative research findings, the study hypothesised that patients with CHD with continuing cardiac symptoms may differ in their psychometric characteristics when compared with patients reporting other problems. 8,10 This study aimed to use PSYCHLOPS in a primary care cohort of patients with CHD in order to define categories of patient concern. The psychometric characteristics of each of these categories of concern were then to be defined.…”