Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T01:02:06.630Z Has data issue: false hasContentIssue false
  • English
  • Français

Depression means different things: A qualitative study of psychiatrists' conceptualization of depression in the palliative care setting

Published online by Cambridge University Press:  21 October 2014

Felicity Ng ,
Gregory B. Crawford  and
Anna Chur-Hansen
Felicity Ng*
Affiliation:
Consultation–Liaison Psychiatry, Lyell McEwin Health Service, Northern Adelaide Local Health Network, Elizabeth Vale, South Australia, Australia Discipline of Psychiatry, School of Medicine, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia
Gregory B. Crawford
Affiliation:
Discipline of Medicine, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia Central Adelaide Palliative Care Service, Central Adelaide Local Health Network, Woodville, South Australia, Australia
Anna Chur-Hansen
Affiliation:
School of Psychology, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia
*
Address correspondence and reprint requests to: Felicity Ng, Mental Health Unit, Lyell McEwin Health Service, Oldham Road, Elizabeth Vale, South Australia 5112, Australia. E-mail: felicity.ng@adelaide.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Medical practitioners conceptualize depression in different ways, which adds to the challenges of its diagnosis and treatment, as well as research in the palliative care setting. Psychiatric assessment is often considered the “gold standard” for diagnosis, therefore how psychiatrists conceptualize depression in this setting is pertinent. Our study aimed to investigate this issue.

Method:

Psychiatrists working in palliative care in Australia were individually interviewed using a semistructured approach. Nine participants were interviewed to reach data saturation. Interview transcripts were analyzed for themes.

Results:

Three overarching themes were identified: (1) depression means different things; (2) depression is conceptualized using different models; and (3) depression is the same concept within and outside of the palliative care setting. Participants explicitly articulated the heterogeneous nature of depression and described a different breadths of concepts, ranging from a narrow construct of a depressive illness to a broader one that encompassed depressive symptoms and emotions. However, depressive illness was a consistent concept, and participants considered this in terms of phenotypic subtypes. Participants used three models (spectral, dichotomous, and mixed) to relate various depressive presentations.

Significance of Results:

Psychiatrists did not subscribe to a unitary model of depression but understood it as a heterogeneous concept comprised of depressive illness and other less clearly defined depressive presentations. Given the influence of psychiatric opinion in the area of depression, these findings may serve as a platform for further discussions to refine the concepts of depression in the palliative care setting, which in turn may improve diagnostic and treatment outcomes.

Keywords

DepressionPalliative careTerminal careConcept formationPsychiatry
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1223 - 1230
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Akiskal, H.S. & Pinto, O. (1999). The evolving bipolar spectrum: Prototypes I, II, III, and IV. Psychiatric Clinics of North America, 22(3), 517–534, vii.Google Scholar
American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC: American Psychiatric Association.Google Scholar
Angst, J., Sellaro, R. & Merikangas, K.R. (2000). Depressive spectrum diagnoses. Comprehensive Psychiatry, 41(2 Suppl. 1), 39–47.Google Scholar
Ayuso-Mateos, J.L., Nuevo, R., Verdes, E., et al. (2010). From depressive symptoms to depressive disorders: The relevance of thresholds. British Journal of Psychiatry, 196(5), 365–371.Google Scholar
Block, S.D. (2000). Assessing and managing depression in the terminally ill patient: ACP–ASIM End-of-Life Care Consensus Panel. American College of Physicians, American Society of Internal Medicine. Annals of Internal Medicine, 132(3), 209–218.Google Scholar
Bowen, G.A. (2008). Naturalistic inquiry and the saturation concept: A research note. Qualitative Research, 8(1), 137–152.Google Scholar
Boyce, P. & Hadzi-Pavlovic, D. (1996). Issues in classification, I: Some historical aspects. In Melancholia: A disorder of movement and mood. Parker, G. & Hadzi-Pavlovic, D. (eds.), pp. 9–19. Cambridge: Cambridge University Press.Google Scholar
Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.Google Scholar
Braun, V. & Clarke, V. (2013). Interactive data collection, 1: Interviews. In Successful qualitative research: A practical guide for beginners, pp. 77–106. London: Sage Publications.Google Scholar
Farmer, A. & McGuffin, P. (1989). The classification of the depressions. Contemporary confusion revisited. British Journal of Psychiatry, 155(4), 437–443.Google Scholar
Galatzer-Levy, I.R. & Galatzer-Levy, R.M. (2007). The revolution in psychiatric diagnosis: Problems at the foundations. Perspectives in Biological Medicine, 50(2), 161–180.Google Scholar
Golden, R.N., McCartney, C.F., Haggerty, J.J. Jr., et al. (1991). The detection of depression by patient self-report in women with gynecologic cancer. International Journal of Psychiatry in Medicine, 21(1), 17–27.Google Scholar
Horwitz, A.V. & Wakefield, J.C. (2007). Loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. London: Oxford University Press.Google Scholar
Jacob, K.S. (2009). Major depression: Revisiting the concept and diagnosis. Advances in Psychiatric Treatment, 15(4), 279–285.CrossRefGoogle Scholar
Jansson, A. (2011). Mood disorders and the brain: Depression, melancholia, and the historiography of psychiatry. Medical History, 55(3), 393–399.Google Scholar
Jefford, M., Mileshkin, L., Richards, K., et al. (2004). Rapid screening for depression: Validation of the Brief Case-Find for Depression (BCD) in medical oncology and palliative care patients. British Journal of Cancer, 91(5), 900–906.Google Scholar
Kendell, R.E. (1976). The classification of depressions: A review of contemporary confusion. British Journal of Psychiatry, 129(1), 15–28.Google Scholar
Kendler, K.S. & Gardner, C.O. Jr. (1998). Boundaries of major depression: An evaluation of DSM–IV criteria. The American Journal of Psychiatry, 155(2), 172–177.Google Scholar
McPherson, S. & Armstrong, D. (2006). Social determinants of diagnostic labels in depression. Social Science & Medicine, 62(1), 50–58.Google Scholar
Misbach, J. & Stam, H.J. (2006). Medicalizing melancholia: Exploring profiles of psychiatric professionalization. Journal of the History of the Behavioral Sciences, 42(1), 41–59.Google Scholar
Mizushima, J., Sakurai, H., Mizuno, Y., et al. (2013). Melancholic and reactive depression: A reappraisal of old categories. BMC Psychiatry, 13(1), 311.Google Scholar
Morse, J.M. (1995). The significance of saturation. Qualitative Health Research, 5(2), 147–149.CrossRefGoogle Scholar
Mulder, R.T. (2008). An epidemic of depression or the medicalization of distress? Perspectives in Biological Medicine, 51(2), 238–250.Google Scholar
Ng, F., Crawford, G.B. & Chur-Hansen, A. (2014 a). How do palliative medicine specialists conceptualize depression? Findings from a qualitative in-depth interview study. Journal of Palliative Medicine, 17(3), 318–324.Google Scholar
Ng, F., Crawford, G.B. & Chur-Hansen, A. (2014 b). Palliative medicine specialists' causal explanations for depression in the palliative care setting: A qualitative in-depth interview study. BMJ Supportive & Palliative Care. Epub ahead of print 28 April 2014. doi: 10.1136/bmjspcare-2013-000626.Google Scholar
Noorani, N.H. & Montagnini, M. (2007). Recognizing depression in palliative care patients. Journal of Palliative Medicine, 10(2), 458–464.Google Scholar
Parker, G. (2000). Classifying depression: Should paradigms lost be regained? The American Journal of Psychiatry, 157(8), 1195–1203.Google Scholar
Parker, G. (2005). Beyond major depression. Psychological Medicine, 35(4), 467–474.Google Scholar
Paykel, E.S. (2008). Basic concepts of depression. Dialogues in Clinical Neuroscience, 10(3), 279–289.Google Scholar
Pessin, H., Olden, M., Jacobson, C., et al. (2005). Clinical assessment of depression in terminally ill cancer patients: A practical guide. Palliative & Supportive Care, 3(4), 319–324.Google Scholar
Power, D., Kelly, S., Gilsenan, J., et al. (1993). Suitable screening tests for cognitive impairment and depression in the terminally ill: A prospective prevalence study. Palliative Medicine, 7(3), 213–218.Google Scholar
QSR International (2011). NVivo qualitative data analysis software. Doncaster, England: QSR International.Google Scholar
RANZCP (2013). About the college. Available at http://www.ranzcp.org/About-us/About-the-College.aspx.Google Scholar
Restifo, S. (2012). A nosological review of depressive disorders based on observations in clinical practice, part 1: Terminology and phenomenology. Australasian Psychiatry, 20(6), 483–486.Google Scholar
Restifo, S. (2013). A nosological review of depressive disorders based on observations in clinical practice, part 2: A working typology for clinicians. Australasian Psychiatry, 21(1), 13–16.Google Scholar
Schumann, I., Schneider, A., Kantert, C., et al. (2012). Physicians' attitudes, diagnostic process and barriers regarding depression diagnosis in primary care: A systematic review of qualitative studies. Family Practice, 29(3), 255–263.Google Scholar
Stiefel, R., Die Trill, M., Berney, A., et al. (2001). Depression in palliative care: A pragmatic report from the Expert Working Group of the European Association for Palliative Care. Supportive Care in Cancer, 9(7), 477–488.Google Scholar
Thomas-MacLean, R. & Stoppard, J.M. (2004). Physicians' constructions of depression: Inside/outside the boundaries of medicalization. Health (London), 8(3), 275–293.Google Scholar
van Praag, H.M. (2000). Nosologomania: A disorder of psychiatry. World Journal of Biological Psychiatry, 1(3), 151–158.Google Scholar