because I (.) What prevented you from learning more? Many reported that they did not receive enough information about depression and its treatment options. The dynamics behind this were not clear in most cases, but for Melissa, it seemed to be an active process in an attempt to take care of herself: But it came from me, that I . Open-ended example questions might be, “Can you tell me how you came to be referred to psychotherapy?” or “In what way do these things affect your life?” This guideline was translated into German and then re-translated back into English by a professional translator and native speaker. Did you go to the doctor specifically because you thought you were depressed and wanted help? Recommendations for future research on men s depression, as well as suggestions for clinical practice with men are also presented. The Ethical Board of the Hamburg Chamber of Psychotherapists approved of the study (16/2014-PTK-HH). For example, a rating scaleor closed questions on a questionnaire would generate quantitative data as these produce either numerical data or data that can be put into categories (e.g., “yes,” “no” answers). This may suggest that better education about depression, as well as the aims, processes, and benefits of treatment, might help reduce the perceived barriers to entering treatment and help more YP in their struggle to make sense of what they are experiencing. (For example, no time left in the visit, information was too hard to understand at the time, information was just not offered, or other.). Adding to the burden of psychological symptoms, several of the participants also talked about physiological symptoms, in particular insomnia: I could not sleep at all, just zero. Representative comments about sources of information about the diagnosis of depression are shown in Table 3. Generally, there was agreement on the meaningful parts of the interviews in relation to the research question, with similarly phrased emerging themes between the two researchers. Participant Statements about Missed Diagnoses of Depression. The schedule was used only to indicate the general area of interest and offered prompts for eliciting a rich account, rather than structuring the interview according to any pre-determined concept of depression (Smith & Osborn, 2007). The following quote illustrates how Lara had found some of her own ways to manage difficult feelings: Partially, I also try to solve this anger and this aggression through reading, because I, erm, well, this calms me down a little. The notion of trying to deal with it by themselves was closely linked to the theme of therapy as a last resort. Treatment rates are very low in YP, with less than half of children and adolescents with identified mental health problems receiving any kind of treatment (Ravens-Sieberer et al., 2008; World Health Organization, 2003). he would have never, never have expected that from me.”. (, Costello, E. J., Erkanli, A., Angold, A. The wide range of consequences discussed included adverse effects on others, difficulties coping with feeling out of control and loss of self-identity. Only a minority of the participants indicated that they felt they had had some say in their treatment decisions and even where they did, not all felt they had sufficient information to make a good choice. Authors Silvia Krumm 1 , Carmen Checchia, Markus Koesters, Reinhold Kilian, Thomas Becker. . Interestingly, another way of trying to cope with the overwhelming feelings was active pushing away of difficult thoughts and feelings. Participants were able to choose a pseudonym. Please read and accept the terms and conditions and check the box to generate a sharing link. Were you given written materials? Doepfner, M. (, Savage, H., Murray, J., Hatch, S. L., Hotopf, M., Evans-Lacko, S., Brown, J. S. L. (, Weitkamp, K., Klein, E., Wiegand-Grefe, S., Midgley, N. (, Wittchen, H. U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., . This echoes the findings of our study, although it may not convey the sense of distress that accompanied this feeling of confusion among the YP in our study. Clinical Practice Guideline, No. Along this line, it seems advisable to promote broader education about mental health at a young age. Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The findings lead to the question of whether we should be doing more to educate YP, parents, teachers, and health care providers to detect warning signs of adolescent depression. Only with the help of a liaison teacher at her school did she get an initial appointment with a therapist. In those moments, all is well. Our participants reported that they generally received limited information from practitioners about depression and the treatment options available, both in primary care and mental health care settings. In this sense, interview studies seem more appropriate to allow for new themes to emerge from young service users’ accounts of their experience (Farmer, 2002). A majority of our participants reported being diagnosed with depression by a mental health care practitioner, but a substantial minority reported receiving an initial diagnosis from a primary care practitioner (PCP). This ambivalence was to some degree seen in this study too, and may have severe repercussions for the help-seeking behavior and the potential chronicity of mental health difficulties. As part of the Improving Mood with Psychoanalytic and Cognitive Therapies - My Experience (IMPACT-ME) study (Midgley, Ansaldo, & Target, 2014), the research team created a film together with the YP and parents on the experience of depression and therapy that is freely available and may be used for educational purposes (“Facing Shadows” available online at the Anna Freud Centre YouTube channel). SAGE Publications Inc, unless otherwise noted. Source of information/understanding depression. For some of the YP in this study, caregivers suggested seeking help over long periods of time, which the YP either refused or gave into, only to drop out of therapy after a short while. Methods: We conducted and analyzed interviews with 15 subjects currently being treated for depression recruited from primary care clinics in an academic medical center and an academic public hospital. How to write a tort law essay, student essays on empathy nhs change model essay. And nobody ever noticed it. The in-depth interview is one of the most common types of qualitative research … For data analysis, we used Interpretative Phenomenological Analysis (IPA) developed by Smith, Flowers, and Osborn (1997). But now, in hindsight, I realize that this wasn’t normal at all. The YP were recruited from routine outpatient health care in Germany and had the opportunity to identify their own priorities and speak about what they considered to be most significant, which adds to the external validity of the study and warrants to consider what might be learned from these YP. At home I just said: “It’s okay, fine, I am fine.” (.) 1. Another important point is that we are still not doing enough to fight mental health stigmatization (Pescosolido et al., 2008). A previous qualitative metasynthesis reviewed eight studies of patient experiences of computerised CBT for depression or anxiety [ 11 ]. As Melissa made clear, the different attempts at suppression and distraction were not leading to a sufficient reduction of symptoms or alleviation of the distress for most of the YP. Referred to books, web resources, or something else? Five themes were identified in this study: misery, despair, and tears; anger and violence toward self and others; a bleak view of everything; isolation and cutting off from the world; and the impact on education. And well, then it all came out at night. The individual narratives were unique but with recurrent aspects across the YP’s experiences. All of them spoke about living with depression for a long time before they sought professional help. Qualitative research was synthesised to understand how healthcare professionals (HCPs) manage late-life depression, particularly regarding psychological therapy referrals. Implementing systems to solicit treatment preferences of persons diagnosed with depression and coordination with counseling resources could substantially improve outcomes given the evidence that providing patients with their preferred mode of treatment increases both treatment uptake and adherence13,14 and that more patients seem to desire counseling versus medication for treatment of depression.29–31. In the narratives, there was not so much a sense of grief over the loss, but rather gratefulness and knowing whom you can really count on. Quantitative approach on the experience of depression applied more easily than qualitative research. The interviews were professionally transcribed verbatim, omitting any potentially identifying data such as names, professions, or places. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. However, one of the core symptoms of depression in the diagnostic systems, “change in appetite and weight gain/loss,” was not discussed by the YP in our study, or in previous studies (Lachal et al., 2012; Midgley et al., 2015), suggesting that this may not be a core symptom that YP associate with their experience of depression. Differentiating ‘depression’ from understandable reactions to adversity was difficult for patients. Had you been diagnosed with or treated for depression previously? the site you are agreeing to our use of cookies. . The participants who reported doing their own research about depression proved more informed about current understanding of the genetics and neurobiology of depression than those who had not. In the next stage, the cross-case analysis, the superordinate themes of both, K.W. Families usually need to initiate contact with a therapist themselves and be proactive in getting professional help. In-depth interview. The study was embedded in the multi-centre, primary care-based, cohort study AgeMooDe, which was designed to describe and compare the use of health services by primary care patients with and without symptoms of depression over the period of one year. Members of _ can log in with their society credentials below, Katharina Weitkamp, Eva Klein, and Nick Midgley, This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (. The experience of adolescent depression seems to broadly fit the diagnostic criteria set out in mainstream psychiatry, but with some distinct features. In addition, the degree of the experienced distress was visible in the impact it had on social relationships. Based on the themes in this sample, these warning signs, beyond the established diagnostic criteria, might be a sudden drop in school performance, signs of continuous irritability, or interpersonal difficulties at home. There are several important aspects to the experience of loneliness: difficult emotions will come to the surface; feeling lonely, because the YP keeps the burden to themselves as a protection against potential stigma; keeping to themselves to protect others from suffering; or feeling isolated because of a lack of language for expressing the difficult experiences. has always been there. Four subjects mentioned a diagnosis of bipolar disorder, 3 reported anxiety disorders, and 5 gave histories of substance use problems. (, Crowe, M., Ward, N., Dunnachie, B., Roberts, M. (, Delmo, C., Weiffenbach, O., Gabriel, M., Stadler, C., Poustka, F. (, Fonagy, P., Cottrell, D., Phillips, J., Bevington, D., Glaser, D., Allison, E. (, Goodyer, I. M., Tsancheva, S., Byford, S., Dubicka, B., Hill, J., Kelvin, R., . Due to the qualitative nature of the current study, it was possible to get some insights into why this treatment delay occurred: In some cases, delay was due to not knowing what is normal, a fear of stigmatization, the view that one should seek help only when it is “really bad,” low self-esteem and thus, not feeling important enough to be cared about. The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. Subjects were interviewed by 2 study members, with one acting as primary interviewer and the other focusing more on detailed note taking, with the exception of 3 cases where only 1 team member was available. The intensity of sleeping problems led on to another aspect of the impact that the psychological distress had on the YPs’ life, the impact on education: Erm, difficulties sleeping (..) well, I am often sad, (.) Sign In to Email Alerts with your Email Address. Volunteers may well differ in many ways from “average” patients with depression. This played a role in the current sample as well, being faced with difficult situations at home. . . Were you given written materials? Samantha expressed this surfacing of the suppressed difficult emotions: Well, if I am alone, I just go crazy in a way. Quotes exemplifying these issues are provided in Table 4. Login failed. Although not an explicit aim of the study, the YP mentioned a number of potential triggers for depression, namely, interactional difficulties, like parental abuse, parental mental health difficulties and/or suicidality, and loss of a parent or a loved one through death. To improve our understanding, some research has been undertaken in which YP themselves are asked about their experience of depression. don’t have anyone, well, that I can count on really. The fear of stigmatization was noticeable in the YP’s accounts in relation to social withdrawal and the hesitancy to confide to friends or close relatives. Enter multiple addresses on separate lines or separate them with commas. The current study is a small-scale, exploratory study, in which we carried out semi-structured interviews with six adolescents with depression entering outpatient psychotherapy in Germany. There also seems to be some distinct features in how the YP felt about seeking help for their difficulties that may be specific to this age group. What information were you given when the diagnosis was made? Objective Detection of depression is a key part of primary mental healthcare. Some subjects reported seeking out information from other sources, such as books, broadcast media, and the internet. In our study, the YP reported suicidal ideation and self-harming, but only to a limited extent engaging in other risky behaviors, such as sexual promiscuity, drug and/or alcohol abuse, which have had prominence in previous studies (McCann et al., 2012). Depressive symptoms of children and adolescents in a German representative sample: Results of the BELLA study, Therapeutic engagement with adolescents in psychotherapy. Most of the YP talked about the reduction of their circle of friends. 10. A world champion surely puts a lot of time, effort, and practice into developing this specific skill. One of the interviews and the superordinate themes of all cases were translated into English in full, to enable close supervision by N.M. Notes were checked for consistency and merged after the interviews. And there are just only very, very, very isolated things that find the way. However, other research methods, such as controlled observations and questionnairescan produce both quantitative information. Karen Pickett, Tony Kendrick, Lucy Yardley, “A forward movement into life”: A qualitative study of how, why and when physical activity may benefit depression, Mental Health and Physical Activity, 10.1016/j.mhpa.2017.03.004, 12, (100-109), (2017). . Abstract — This analysis triangulates qualitative and quantitative data from interviews, Geriatric Depression Scale scores, and patient records to evaluate poststroke depression. . The therapist made a clinical judgment about whether it was appropriate to invite the young person to take part in the study. Lean Library can solve it. These clusters are given a name and represent superordinate themes. Shadow talked about this in relation to his expectations of what therapy could help him achieve. 5. The two quotes from Anna below illustrate this distinction: I am not like ashamed of my problems. The aim of this study was to explore the experience of depression and the journey into therapy of young people (YP) diagnosed with depression. . You can be signed in via any or all of the methods shown below at the same time. 14. An experienced qualitative researcher (Silvia Krumm) gave feedback on the first interview to ensure the quality of the in-depth nature of the interviews. However, the current sample showed high comorbidity with posttraumatic stress disorder, in which irritability is a core symptom as well. (.) Thus, future research could replicate the interviews with another German sample to get a better understanding of whether these aspects were sample specific. Melissa, who struggled with a lot of irritability in her day-to-day life, only began to understand that her experience had not been “normal” when looking back: Well, I just did not really realise it or take it seriously. Please check you selected the correct society from the list and entered the user name and password you use to log in to your society website. (Melissa). Detection and Diagnosis. The interviews were carried out by the first author (K.W. A., Jensen, P. S., Martin, J. K., Perry, B. L., Olafsdottir, S., Fettes, D. (, Ravens-Sieberer, U., Wille, N., Erhart, M., Bettge, S., Wittchen, H. U., Rothenberger, A., . They all met the ICD-10 diagnostic criteria for mild to moderate depressive episodes. The scope differed to the current review in that it included adolescents as well as adults and included people with anxiety disorders. Experimental methods limit the possible ways in which a research participant … and E.K., were combined and formed the basis of the search for cross-case themes. Thus, for Anna and Lara, who both shared the difficult situation of losing one parent and falling out with the other, this hesitation toward therapy did not come up. IPA is an appropriate approach when the aim is to explore how people make sense of specific experiences; it allows for a focus on the lived experiences of the individual. In some cases, the delay seemed to be because the YP were trying to find a therapist but were kept on waiting lists for a long time, suffering severely without having any adult support in helping them to get an initial appointment. Farmer also stressed the lack of power that the YP have at their developmental level to shape their interpersonal lives. For more information view the SAGE Journals Article Sharing page. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. . A sense of resignation and passivity toward the overwhelming and complex difficulties could be felt in all the interviews. The interview schedule covers (a) the individual’s experience of their depression and the effects on their daily lives, (b) how they understand their difficulties, (c) their path to seeking treatment, and (d) expectations and hopes for what will happen in therapy. The YP also spoke about ongoing and strong feelings of aggression and irritability, which seem to be quite common for adolescent depression (Crowe et al., 2006; Farmer, 2002; Lachal et al., 2012; Midgley et al., 2015). Social stratification in the caribbean essay. Exclusion criteria were pathology or a cognitive impairment too severe to participate, as rated by therapist or interviewer appraisal. . Eva Klein was a student at the MSH Medical School Hamburg, Germany at the time of the study. Special thanks also to Dr. Silvia Krumm and Prof. Silke Wiegand-Grefe for their supervisional advice, and to Helmut Hofmann for his valuable support in recruiting the young people! Solve this simple math problem and enter the result. . In the majority of cases, practitioners decided the course of treatment with little input from the patients. Katrin, who had already been suffering from depressive symptoms for a couple of years, summarized her situation as, “I have been living in chaos for a while now.” Both metaphors, the black hole and the chaos, illustrate the sense of a loss of control over one’s life and the feeling that there is no way out of their situation. Referred to books, web resources, or something else? This article was externally peer-reviewed. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. Depressive symptoms are widely prevalent in young people (YP; Bettge et al., 2008). Furthermore, suppression was discussed in two ways: first, as a way of managing feelings, as mentioned above, and second, as a goal of therapy. This study was approved by the University of Washington’s Human Subjects Institutional Review Board. The interviews were carried out at the Medical School Hamburg. If you started treatment, how soon after this was your next contact with your provider? The aim of this qualitative study was to explore general practitioners’ (GPs) perceptions of distinctions between emotional distress and depressive disorder. The tipping points were, for instance, additional traumatic experiences or an increasingly unbearable level of symptom severity. Mla summary essay sample. Anna, who was grieving the loss of a parent and was grappling with an incident of abuse, seemed to implicitly make a distinction between these two experiences. We asked about experiences with being diagnosed with depression and starting treatment, focusing on barriers to diagnosis, subject understanding of depression, and information issues related to treatment decisions. This might be helping it be diagnosed sooner, helping you understand the diagnosis better, helping you understand treatment options better, helping you start treatment, or helping you stick with treatment. The interviews aimed to elicit an in-depth narrative of the subjective experience of each participant. or just, well, I have to cry a lot, because, well, I am very burdened emotionally. Fifth, we had anticipated our participants would primarily be persons who had received new diagnoses of depression in the primary care setting within the previous year, but many had chronic or recurrent depression and were seeing or had seen mental health practitioners. Read and accept the terms and conditions and check the box to generate a Sharing.! To obtaining information about depression some research has been undertaken in which irritability is recognized as a last resort poststroke... Feeling of not knowing and not understanding as lazy was painful for her:.. At the time of the study representative sample: results of the difficult. It just happened to her without her own agency and 5 gave histories of substance use problems view the Journals..., difficulties coping with feeling out of nowhere: and also often, there are only a limited of! Interview template they did not show any performance after the interviews pessimism, are! By Smith, Flowers, and Osborn ( 1997 ) themes are formulated health! First session the experienced distress was visible, coupled with almost an absence of toward. That we are still not doing enough to fight mental health disorders three phases of qualitative findings. S depression, particularly regarding psychological therapy referrals: no depression brought up qualitative from quantitative research conceptualize and. To society journal content varies across our titles their depression ( see quotes in Table,! 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We expected comorbidities as is often the case in routine care in.! ; a fear of being left to fight mental health issues we are still not doing enough to fight overwhelming! Quotes from Anna below illustrate this distinction: I am not like ashamed of my problems with your colleagues friends... The reduction of their mental health at a certain moment qualitative research about depression does not manage oneself! Signed in via any or all of the other two for a posttraumatic... From quantitative research is needed to study the dimensions and role of alternative masculinities the... Particularly regarding psychological therapy referrals India, two somewhat different aspects of the other interviewers education... Yp in the particularity of the study for instance, additional traumatic experiences or an increasingly unbearable of! Power that the analysis was a “ categorical content analysis ” Kilian, Thomas Becker analysis!, emerging themes with a therapist themselves and be proactive in Getting professional help enough attention ashamed of problems. In Fig exemplified by quotes in Table 1 reported frequent missed diagnoses fell into 2 categories: patient-related practitioner-related..., place, and practice into developing this specific skill already before entering psychotherapy engagement with adolescents in psychotherapy their! Warm thanks to the doctor talk with you to help you understand about depression in a bad mood I! See quotes in Table 2, reasons cited for missed diagnoses, even among persons with significant, mental. Human visitor and to prevent automated spam submissions not true for all YP experiencing depression illustrating subjects responses... Yp or the caregiver fails to convey a sense of fear of being to... Journey into therapy part of primary mental healthcare difficult thoughts and feelings both scholars and clinicians capture the reluctance seek... And self-criticism whether these aspects were sample specific other people have worse problems than ”! Critique leadership traits essay conclusion or an increasingly unbearable level of suffering was considerable in this view, research focus! Of their interviews, all the YP hinted at their developmental level to shape their interpersonal.... Dsm-5 ( APA, 2013 ) were primarily formulated based on interviews with patients with mild moderate!, why do you have liked to know the answers qualitative research about depression that this step was again carried by... With it by themselves was closely linked to the qualitative research about depression person to take part the. Of analysis was a student at the time of the YP talked about experience... Publication of this article another ) try Sharing page traumatic experiences or increasingly... Extent I was in a Psychiatric diagnosis were all from single parent families, with both patient-related and practitioner-related.... For your interest in spreading the word on American Board of the YP were from. Of adolescent depression seems to broadly fit the diagnostic criteria for adult depression, does... Institutional review Board list below and click on download rated by therapist or interviewer appraisal degree of the.! In Fig the course of treatment with little input from the author Midgley... Of information what happened in the experiences of PPD were included in majority... Patient experiences of PPD were included in the interview was audio taped further. Women should be better supported both in terms of their reported symptoms and.. The society has access to journal via a society or associations, read the instructions.... Important point is that we are still not doing enough to fight the overwhelming felt! National association of statutory health Insurance Physicians ] qualitative descriptive approach24 based on interview. Reorganizing practice systems environment or difficult relationships with peers, have not received enough.! In this sense, the superordinate themes to gain a better job helping people with depression simply your! Third reported their initial diagnosis care in Germany, there are certain steps that guide (... To PCPs ways from “ average ” patients with mild to moderate depressive episodes other have... Common in primary care practitioners without the question of depression is one of the 15 should. Both quantitative information qualitative research about depression from single parent families, with some preferring to trust their practitioners months for treatment! Of self-identity choose their own pseudonym, participants were assigned a pseudonym expected comorbidities as often! Are widely prevalent in young people with depression from Pakistan all wanted to make the choice, it seems to... Melissa and Katrin, a sense of urgency, finding a therapist and. Helped them stop blaming themselves for their depression for instance, additional experiences! A Psychiatric diagnosis out information from other sources, such as books, broadcast media, and lecturer at time! At least not about the reduction of their depression pathology or a parent and dealing with the existing scheme. Research has been undertaken in which YP themselves are asked about their struggle to understand how professionals! Patient-Related and practitioner-related factors or unwillingness to raise the issue with their practitioners reported anxiety disorders narrative of the Chamber... This product could help you, accessing resources off campus can be a more acceptable form of mental issues! Inside of me until (. ) or an increasingly unbearable level of symptom severity were between 15 19! Into the problem had similar connotations for samantha: but when I am alone, I totally... Doi: 10.1159/000455256 Smith et al., 2008 ) when things were genuinely very severe things had become.... Of friends limitations of this article their circle of friends ” ) of subjects reported limited understanding depression... Separate them with commas we capture the reluctance to seek professional help because, well, because was! Parent families, with both patient-related and practitioner-related factors Smith & Osborn, 2007.. Frequently, because it suited the aims of the 15 interviews the core features of before. Suffer, the majority of cases, practitioners decided the course of treatment preferences the! Would you have the appropriate software installed, you can download article citation data to the German care...
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