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

Authors

  • Bauke Koekkoek,

    1. B. Koekkoek RN CNS
      Clinical Nurse Specialist and Researcher
      Department of Outpatient Community Care, Altrecht Mental Health Care, Zeist; Gelderse Roos Mental Health Care, Institute for Professionalization, Wolfheze, The Netherlands
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  • Berno Van Meijel,

    1. B. van Meijel PhD RN
      Associate Professor
      Research Group Mental Health Nursing, INHOLLAND University for Applied Sciences, Amsterdam, The Netherlands
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  • Aart Schene,

    1. A. Schene MD PhD
      Professor of Psychiatry
      Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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  • Giel Hutschemaekers

    1. G. Hutschemaekers PhD
      Professor of Clinical Psychology
      Gelderse Roos Mental Health Care, Institute for Professionalization, Wolfheze; Academic Center of Social Sciences, Radboud University, Nijmegen, The Netherlands
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B. Koekkoek: e-mail: b.koekkoek@altrecht.nl

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.

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