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What made me feel better?: patients’ own explanations for the improvement of their depression
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
(English)Article in journal (Refereed) Submitted
Abstract [en]

Background: Depression is common among primary care patients and among those recognized the usual treatment often consists of antidepressants and supportive counselling/follow-ups. Previous studies have shown that patients and professionals have different beliefs about treatment which in turn can decrease acceptance of the diagnosis, compliance and treatment outcome.

Methods: Depressed primary care patients (N=184) who considered themselves improved at follow-up answered an open-ended question about what they believed had made them better. Among these 117 patients had, in addition to treatment as usual, participated in an intervention with patient education and group counselling (the Contactus program) while 67 were controls. The groups were comparable at baseline and 82 % were on antidepressants.

Results: In total, the patients mentioned 14 separate improving factors which could be organized to the larger themes external factors, self-management, passing spontaneously and professional help. The most frequently mentioned factors for improvement were the Contactus program (53.0 %), antidepressants (40.2 %) and personal development (27.2 %). Few gender and age differences were seen. The controls who mentioned professional help were more likely to have a better outcome.

Limitations: The construct of the open-ended question did not allow us to analyze the rank order of importance of each improving factor.

Conclusions: The patients were generally positive to professional help such as antidepressants and the Contactus program. Patient education and group counselling seems to be a valuable supplement to treatment of depressed patients in primary care.

URN: urn:nbn:se:umu:diva-30521OAI: diva2:284416
Available from: 2010-01-07 Created: 2010-01-07 Last updated: 2011-05-17Bibliographically approved
In thesis
1. Depression in primary care: detection, treatment, and patients’ own perspectives
Open this publication in new window or tab >>Depression in primary care: detection, treatment, and patients’ own perspectives
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Depression is a very common disorder that causes great suffering for the patient. Recognizing depressed patients in primary care (PC) settings is a challenge and only about half are identified as depressed by their general practitioner (GP). Among patients receiving antidepressants (AD) about 70 % are improved, but only about 35 % reach remission. Hence, there is a need to identify depressed patients and to develop optimal treatment strategies in PC. Self-rating scales can be helpful in assisting the recognition. Patients’ beliefs about the cause of depression and their attitudes towards treatment options have been found to influence their help-seeking behavior, coping strategies, treatment preferences and adherence. To increase depressed patients’ knowledge about their disorder and to help them reach and stay in remission, the “Contactus program” was launched in Sweden, containing patient education and group counseling, as supplement to the usual care in PC.

Aims To explore patients’ beliefs about causes and improvement factors for depression, and evaluate if the Contactus program could help to improve treatment outcome. Also, to investigate the psychometrics of two commonly used self-rating scales for depression, HADS and PHQ-9.

Methods Treatment outcome among patients participating in the Contactus program (N=205) was compared to a control group (N=114) treated as usual. The outcome was measured by HADS, GAF-self and by questionnaires. Both groups also answered an open-ended question about the cause of their depression at baseline and another question about improvement factors at follow-up after six weeks. To compare HADS and PHQ-9, patients (N=737) visiting their physician because of depression filled in both scales. The scales cut-offs were compared with Cohen’s Kappa, internal consistency was calculated and factor analysis was performed. 

Results Depressed patients participating in the Contactus program had a response rate of 55 % compared to 29 % in the control group (p=0.006). Also, remission was reached among 42 % in the Contactus group and 21 % among the controls (p=0.02). The patient’s subjective evaluation of the outcome after six weeks showed that 72% of the Contactus patients considered themselves improved vs. 47% among controls (p=0.01). The most common described reason for depression was current stress, most often work related, and own personality traits. Very few mentioned biological factors. For improvement, the most commonly mentioned aspects were participation in the Contactus program and AD. When comparing HADS to PHQ-9 their agreement at recommended cut-offs, HADS-D≥11 and PHQ-9≥10, was low (k=0.35). The highest Kappa value (0.56) and also equal prevalence of depression were found at HADS-D≥8 and PHQ≥12. Both scales had a high internal consistency (α=0.9).

Conclusions The results of this thesis indicate that patient education and group counseling are valuable supplements to usual treatment of depression in PC. It is also clear that patients and professionals often have different opinions about the causes of depression, at least concerning biological factors. The patients were generally positive to professional help. The patients’ own beliefs about their illness must be considered when developing new types of interventions and when trying to reach an understanding in the patient-doctor encounter. Finally, there are many self-rating scales for depression. Here two scales were compared and both showed good psychometric properties in terms of internal consistency and factor structure. However their optimal cut-offs were questioned. In conclusion, self-rating scales are useful in identifying depressed patients in PC and might also be apt for measuring treatment outcome. Offering the patient education about their disorder and possibility to share experiences seems to increase response and remission rates, substantially. More studies are needed to explore the effects of educational programs, group interventions, and how patients’ own believes interact with the choice of treatment, adherence and outcome.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2010. 63 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1308
Depression, primary care, patient education, group counselling, patients’ beliefs, treatment, causes, self-rating scales, HADS, PHQ-9
National Category
Research subject
urn:nbn:se:umu:diva-30516 (URN)978-91-7264-891-3 (ISBN)
Public defence
2010-01-29, Sal B, Tandläkarhuset, 9 tr, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Available from: 2010-01-09 Created: 2010-01-07 Last updated: 2010-01-18Bibliographically approved

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