Why may older people with depression not present to primary care? Messages from secondary analysis of qualitative data

Chew‐Graham, Carolyn; Kovandžić, Marija; Gask, Linda; Burroughs, Heather; Clarke, Pamela; Sanderson, Helen; Dowrick, Christopher

doi:10.1111/j.1365-2524.2011.01015.x

Cited by 72 publications

(90 citation statements)

References 25 publications

(57 reference statements)

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“…We have published the main findings on commonalities between groups in a paper by Kovandžić et al 345 and some of the findings related to specific groups included in this study in a paper by Chew-Graham et al 346 Here we outline the main findings, illustrated with some quotations from the data. Our analysis points to an extensive overlap in access-related issues across the observed groups, along with some particularities.…”

Section: Summary Of Evidencementioning

confidence: 78%

“…The concept of 'double stigma' highlights the fact that members of marginalised groups who also have mental health problems may face compounding sources of stigma and discrimination. 340,346 People from these groups may view their problems through specific cultural or religious lenses, for example the need to be a 'strong black woman' or the belief that problems are a test of faith.…”

Section: Synthesising Evidencementioning

confidence: 99%

“…346 In Chapter 3 we provided our rationale for implementing a complex intervention model with three interlinked components ( Figure 21). …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Summary Of Evidencementioning

confidence: 78%

Section: Synthesising Evidencementioning

confidence: 99%

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Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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“…It is often not recognized and undertreated in older adults in primary care, especially in those with chronic physical illness (48). These data suggest that the successful results of trials treating depression in persons with OA (49) can be extended to an effect on improving participation in older people with multiple medical problems alongside their OA.…”

Section: Discussionmentioning

confidence: 99%

Reasons Why Multimorbidity Increases the Risk of Participation Restriction in Older Adults With Lower Extremity Osteoarthritis: A Prospective Cohort Study in Primary Care

Wilkie

Blagojevic‐Bucknall

Jordan

et al. 2013

Arthritis Care & Research

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Objective. To determine why multimorbidity causes participation restriction in adults ages >50 years who consult primary care with lower extremity osteoarthritis (OA). Methods. This was a population-based prospective cohort study of 1,053 consulters for lower extremity OA who were free of participation restriction at baseline. Path analysis was used to test proposed mechanisms by examining for mediation of the association between multimorbidity at baseline, defined by self-report and consultation data separately, and incident participation restriction at 3 years by lower extremity pain severity, obesity, locomotor disability, and depression. Results. Multimorbidity was associated with incident participation restriction (adjusted odds ratio

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“…A marked difference between groups included meeting the language needs of some minority patients, however deep rooted communication issues such as differential mental health models [21], perceived candidacy for treatment [22] and recursivity in cultural expectations of treatment [23] exist in both groups [8]. …”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care

et al. 2014

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BackgroundPsychological therapy is effective for symptoms of mental distress, but many groups with high levels of mental distress face significant barriers in terms of access to care, as current interventions may not be sensitive to their needs or their understanding of mental health. There is a need to develop forms of psychological therapy that are acceptable to these groups, feasible to deliver in routine settings, and clinically and cost effective.MethodsWe developed a culturally sensitive wellbeing intervention with individual, group and sign-posting elements, and tested its feasibility and acceptability for patients from ethnic minorities and older people in an exploratory randomised trial.ResultsWe recruited 57 patients (57% of our target) from 4 disadvantaged localities in the NW of England. The results of the exploratory trial suggest that the group receiving the wellbeing interventions improved compared to the group receiving usual care. For elders, the largest effects were on CORE-OM and PHQ-9. For ethnic minority patients, the largest effect was on PHQ-9. Qualitative data suggested that patients found the intervention acceptable, both in terms of content and delivery.ConclusionsThis exploratory trial provides some evidence of the efficacy and acceptability of a wellbeing intervention for older and ethnic minority groups experiencing anxiety and depression, although challenges in recruitment and engagement remain. Evidence from our exploratory study of wellbeing interventions should inform new substantive trial designs.Trial registrationCurrent controlled trials ISRCTN68572159

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Why may older people with depression not present to primary care? Messages from secondary analysis of qualitative data

Cited by 72 publications

References 25 publications

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Reasons Why Multimorbidity Increases the Risk of Participation Restriction in Older Adults With Lower Extremity Osteoarthritis: A Prospective Cohort Study in Primary Care

Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care

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