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Keywords:

  • chronic depression;
  • community mental health services;
  • Delphi study;
  • focus group;
  • long-term care;
  • mental health nursing;
  • psychosocial rehabilitation

Abstract

Title. Clinical problems in the long-term care of patients with chronic depression.

Aim.  This paper is a report of a study to explore problems encountered by mental health professionals in the long-term care of patients with chronic depression.

Background.  Patients who do not profit from psychopharmacological or psychotherapeutic treatment often need long-term care. Although they experience severe symptoms and loss of functioning, little is known about these people and the care they receive.

Method.  Experts in chronic depression (n = 8) participated in a four-phase Delphi study in 2006–2007. Problems were elicited through a focus group interview (first round) which was analysed using thematic analysis. The resulting problem list was validated (second round) and scored twice on a 7-point Likert scale (third and fourth rounds) by the participants. Urgency and changeability scores of 35 problems were obtained and a hierarchy of problems was set. In addition, qualitative data from the focus group interview were used to frame the results in the context of long-term care for patients with chronic depression.

Results.  Problems were subdivided into five areas. Relapses by the patient, a pessimistic attitude by the professional and demoralization in both were major problems. Also noted were the negative societal connotations of chronic depression and the lack of a coherent view on treatment within mental health care.

Conclusion.  Chronicity of depression may be denied by both patients and professionals, resulting in an overly strong focus on cure and a limited quality of care. The results may be used as a starting point for construction of a best-practice programme to improve long-term care.