"I Didn't Know What Was Wrong:" How People With Undiagnosed Depression Recognize, Name and Explain Their Distress
"I Didn't Know What Was Wrong:" How People With Undiagnosed Depression Recognize, Name and Explain Their Distress
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DOI：
10.1007/s11606-010-1367-0
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发表时间：
2010-09-01
影响因子：
5.7
通讯作者：
Paterniti, Debora A.
中科院分区：
文献类型：
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作者：
Epstein, Ronald M.;Duberstein, Paul R.;Paterniti, Debora A.
抑郁症的诊断和治疗延迟是由医生和患者因素造成的。患者对其抑郁症状的认识以及将抑郁相关问题就医的能力各不相同。通过了解患者在寻求治疗之前和治疗过程中的内心体验，为初级保健中改善抑郁症的识别和管理提供干预措施。焦点小组，进行定性分析。纽约州罗彻斯特、德克萨斯州奥斯汀和加利福尼亚州萨克拉门托有个人或替代抑郁症病史的一百一十六名成年人（79％的回应）。社区招募策略实现了社会人口多样性。由多学科团队提出并在三个试点焦点小组中完善的开放式问题探讨了参与者的抑郁症“生活经历”、与抑郁症相关的信念、重要他人的影响以及寻求护理的促进因素和障碍。然后，对按性别和收入分层的 12 个焦点小组进行了分组、录音，并使用编码/编辑方法进行定性分析。参与者描述了参与抑郁症护理的三个阶段：“知道”（认识到出了问题）、“命名”（找到词语来描述他们的痛苦）和“解释”（寻求有意义的归因）。 “知道”受到患者性格和社会态度的影响。 “命名”受到抑郁症的个人经历与其狭隘的临床概念、抑郁症一词的口语使用和耻辱之间的不协调的影响。 “解释”受到媒体、社会化过程和社会关系的影响。物理/医学解释似乎有助于寻求护理，但也可能产生有害后果。其他解释（性格、情境）也很常见，可以增强或减少对自己或他人的责备。为了提高对抑郁症的认识，初级保健医生应该警惕患者的不明确的痛苦和异质症状，帮助患者说出他们的痛苦，并提出符合患者生活经历的解释，减少责备和耻辱，并促进就医。
Diagnostic and treatment delay in depression are due to physician and patient factors. Patients vary in awareness of their depressive symptoms and ability to bring depression-related concerns to medical attention.To inform interventions to improve recognition and management of depression in primary care by understanding patients' inner experiences prior to and during the process of seeking treatment.Focus groups, analyzed qualitatively.One hundred and sixteen adults (79% response) with personal or vicarious history of depression in Rochester NY, Austin TX and Sacramento CA. Neighborhood recruitment strategies achieved sociodemographic diversity.Open-ended questions developed by a multidisciplinary team and refined in three pilot focus groups explored participants' "lived experiences" of depression, depression-related beliefs, influences of significant others, and facilitators and barriers to care-seeking. Then, 12 focus groups stratified by gender and income were conducted, audio-recorded, and analyzed qualitatively using coding/editing methods.Participants described three stages leading to engaging in care for depression - "knowing" (recognizing that something was wrong), "naming" (finding words to describe their distress) and "explaining" (seeking meaningful attributions). "Knowing" is influenced by patient personality and social attitudes. "Naming" is affected by incongruity between the personal experience of depression and its narrow clinical conceptualizations, colloquial use of the word depression, and stigma. "Explaining" is influenced by the media, socialization processes and social relations. Physical/medical explanations can appear to facilitate care-seeking, but may also have detrimental consequences. Other explanations (characterological, situational) are common, and can serve to either enhance or reduce blame of oneself or others.To improve recognition of depression, primary care physicians should be alert to patients' ill-defined distress and heterogeneous symptoms, help patients name their distress, and promote explanations that comport with patients' lived experience, reduce blame and stigma, and facilitate care-seeking.