Do you have any other thoughts about how doctors can do a better job helping people with depression? Lean Library can solve it. ; DSM-5; American Psychiatric Association [APA], 2013) were primarily formulated based on adult criteria. Furthermore, suppression was discussed in two ways: first, as a way of managing feelings, as mentioned above, and second, as a goal of therapy. Please read and accept the terms and conditions and check the box to generate a sharing link. As noted above, the limited evidence on educational interventions for depression21,22 does not suggest that education alone is likely to be particularly effective in improving outcomes of depression treatment. The email address and/or password entered does not match our records, please check and try again. In addition, further efforts to lower the barrier to accessing treatment are necessary for this vulnerable group. Little is known about the experience of loneliness among young people with depression. 5. One reason why several of the YP seemed not to seek help sooner was because their self-esteem was very low, so they felt that they were not worth the help and care of others. This article was externally peer-reviewed. However, in the study by Farmer (2002), the YP all came from divorced families as well, although sample selection was not based on parental marital status in either of the two studies. Solve this simple math problem and enter the result. Diminished ability to concentrate or think is a diagnostic criterion in the DSM-5; however, interpersonal problems are not covered (APA, 2013). Participants did not directly discuss sadness, crying, or pessimism, which are the core features of depression in a psychiatric diagnosis. There is a lack of research in health psychology on the subjective experience of adolescents with mental health disorders. On a more interpretative level, two somewhat different aspects of the experience of loneliness seemed to emerge in the sample. Clearly, this is not true for all YP experiencing depression. Well, most people say like, that it is probably because of my father who more or less turned away from me and did not want me anymore. . With an insufficient number of registered therapists even in larger cities, waiting lists are long. Because IPA emphasizes the importance of an in-depth understanding of an individual’s experience, it is mostly used with small homogeneous sample sizes; the authors recommend a sample size of four to eight as appropriate for an IPA study (Smith, Flowers, & Larkin, 2009). In the next step, from the comments and notes on the first transcript, emerging themes are formulated. The impact on education was seen in all the YP, ranging from dropping out of school for a period of time, repeating a grade, to a significant drop in performance at school. (Shadow). Common across the YP’s accounts in the different studies was the struggle to make sense of the situation, social withdrawal, trying to deal with the situation by self-harming, suicidal ideation, and attempts to and/or engaging in risky behavior. To improve our understanding, some research has been undertaken in which YP themselves are asked about their experience of depression. Quotes pertaining to issues of role in choice of therapy are shown in Table 5. Did you initiate the contact or did they? First, the YP touched on the core symptoms of depression as described in the ICD-10 (World Health Organization, 2010) and DSM-5 (APA, 2013). Participant Statements about Prediagnosis Understanding of Depression. 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. About 5.6% of adolescents between 13 and 18 years meet diagnostic criteria for a depressive disorder (Costello, Erkanli, & Angold, 2006), rendering affective disorders of particular relevance for mental health services. 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. It provides insights into the problem or helps to develop ideas or hypotheses for potential quantitative research. . A third theme, which was pervasive in the YPs’ accounts, was the notion of not being able to understand what they were going through. A strength of this study was to listen to the YP’s voices; however, they relied only on standardized measures (Crowe et al., 2006; Lachal et al., 2012), thus potentially limiting the validity, as the YP were only able to report what was asked in the questionnaire. Create a link to share a read only version of this article with your colleagues and friends. This step was again carried out first separately and then discussed to reach conclusion. This included cross-checking between the superordinate themes and the transcript, to ensure that the data interpretation was grounded in the data, and also a discussion of each superordinate theme, to ensure that they were not merely descriptive, but offered a meaningful interpretation of the data in the light of the research questions and the participants’ experiences. Setting :: Eight general practices in the West Midlands and the regional membership of the Depression Alliance. We see this in the interview with Katrin. It involved sampling the fifteen teenagers and the interview was audio taped for further reference. A number of barriers to obtaining information were reported, with both patient-related and practitioner-related factors appearing important. Depression is a common mental health problem leading to significant morbidity and mortality and high medical and societal costs.1–3 The World Health Organization estimated that major depression caused more disability worldwide in 1990 than ischemic heart disease or cerebrovascular disease.4 The prevalence of major depressive disorders in the US population aged 18 years and older has been estimated at 5%,5 and it is one of the most commonly encountered conditions in primary care,6,7 but up to 50% of cases go unrecognized.8,9 In many cases, it is more appropriately viewed as a chronic disorder with remissions and relapses than an acute illness.10–12, Even if diagnosed, care for depression is frequently flawed. However, because comorbidity is the norm among adolescents suffering from depression (Fonagy et al., 2015), this mixed picture is probably reflective of the reality of mental health difficulties in YP today. Prior presentation: A portion of this work was presented at the 33rd North American Primary Care Research Group Annual Meeting, Quebec City, Quebec, October 15–18, 2005. Linked to this idea of therapy as a last resort and the long journey to seek help was, for some of the YP, the question of what is within the range of “normal” adolescent experiences of sadness or irritability. Source of information/understanding depression. These clusters are given a name and represent superordinate themes. Only with the help of a liaison teacher at her school did she get an initial appointment with a therapist. 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. and other studies have shown that stigma is a major barrier to diagnosis and treatment of depression.3,25–28 Education may help to reduce personal stigma associated with depression.22, Most of our participants reported that they would have liked more say in their choice of treatments. Other people have worse problems than me.” but at a certain moment one does not manage by oneself any more. 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). However, our findings are consistent with existing literature on shortcomings in diagnosis and treatment of depression. The interviews aimed to elicit an in-depth narrative of the subjective experience of each participant. Our interviews highlight some key areas where depression care might be improved: screening for depression; patient education about current understanding of depression and treatment options; improving provider attitudes and knowledge about depression and its treatment where there are gaps; and increasing the collaborative nature of decision making about treatment options. Keywords: men, masculinity, depression, help seeking, grounded theory Major depression is a central concern for both scholars and clinicians. (.) She only got an initial appointment with the help of her liaison teacher and not from her own attempts to contact psychotherapists. 1993, US Department of Health and Human Services: Rockville, MD. Because, to some extent I was able to hide it well from him. well (.) In the meta-synthesis by Dundon, seeking professional help was also covered. Shadow experienced the prospect of therapy and finally getting help as a sign that he might be worth being cared for: And also, well, ehm, that someone is taking care of me, that is helping me in a way, in that I say, well maybe I am important after all, that I say, someone will take care of me and will help me. 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. . There were 7 Caucasian, 6 African American, 1 Asian American, and 1 Native American subjects. The two quotes from Anna below illustrate this distinction: I am not like ashamed of my problems. Data analysis was carried out by the first author (K.W.) Steinhausen, H. C. (. Suicidal thoughts, self-harm, just this completely negative attitude in general. In the interview with Katrin, a sense of aggressive self-hatred was visible, coupled with almost an absence of aggression toward others. (E.g., someone from your doctor’s office called you or they scheduled a follow-up appointment a week or two after you decided to start treatment.). Lack of social support was also an … Some subjects expressed either inability or unwillingness to raise the issue with their practitioners. View or download all content the institution has subscribed to. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Overall, the level of suffering was considerable in this sample. the site you are agreeing to our use of cookies. And where did this begin and so on. This site uses cookies. Our participants reported frequent missed diagnoses, even among persons with recurrent depression. Many researchers conceptualize quantitative and qualitative research as complementary and advocate combining them. Because she kept her difficulties to herself, her parents and her teachers could not understand her behavior and lack of performance at school. View or download all the content the society has access to. In all the interviews, the YP also spoke about irritability and aggression. Whether this was due to the sample or to the YP being hesitant to disclose this information to the interviewer cannot be answered. . The tipping points were, for instance, additional traumatic experiences or an increasingly unbearable level of symptom severity. Eligible patients, referred between September and December 2014 were approached by their therapist for participation after the first session. Did you understand what counseling for depression generally involves? 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, there seemed to be an understanding among our participants that there might be different kinds of mental health problems with differing levels of negative stigma attached to them. Her current research interest is in youth psychotherapy. Dissertation title design Qualitative about paper research depression: qualitative dissertation critique leadership traits essay conclusion. Possible reasons for not inviting the YP were, for example, because they were in a state of crisis or because their mental health felt too precarious at this point to ask them to participate in research interviews. In this study, we report results of qualitative analyses of interviews with patients currently under treatment for depression about their experiences with being diagnosed with and starting treatment for depression. . The purpose of the second interview was to provide a diagnostic assessment and confirm the presence of a depressive disorder; but this data were not used in the qualitative analysis reported below. She finished her degree in psychology (MSc) and is currently in training for cognitive behaviour therapy. The scope differed to the current review in that it included adolescents as well as adults and included people with anxiety disorders. Moreover, the delay in getting professional treatment is a major issue, with many children and adolescents only accessing help a number of years after the onset of the mental health condition and considerably later than adults (Korczak & Goldstein, 2015; McGorry, Purcell, Goldstone, & Amminger, 2011). In this sense, we were particularly looking for data where the YP spoke about their experience of depression, the impact that depression might have on their lives, and their journey into therapy—but we did not in any way pre-determine that themes might emerge in relation to these research questions. Conclusions: In this sample of depressed patients, we found evidence of frequent missed diagnoses, substantial information gaps, and limited patient understanding and choice of treatment options. well, I just perceived it as normal. Clinical Practice Guideline, No. Even when you talked to me directly, I did not notice. But now, in hindsight, I realize that this wasn’t normal at all. Enter multiple addresses on separate lines or separate them with commas. Although the interview seemed to be a viable method for this particular developmental level, for future studies, it might be worth considering whether more creative techniques could be incorporated to facilitate access to the YP’s experiences on a more non-verbal level as well. Well, I would like to know, (.) The individual narratives were unique but with recurrent aspects across the YP’s experiences. You can be signed in via any or all of the methods shown below at the same time. Thus, we might have missed the more anxious spectrum of depressive patients; although some of the YP reported significant social anxieties in their diagnostic interview. Exploring why young adults seek help for social anxiety, Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL): Initial reliability and validity data, Mood disorders in children and adolescents: An epidemiologic perspective, Childhood onset major depressive disorder: Course of illness and psychiatric comorbidity in a community sample, Depression in adolescence: From qualitative research to measurement, The experience of young people with depression: A qualitative study, Age of onset and timing of treatment for mental and substance use disorders: Implications for preventive intervention strategies and models of care, The meaningful assessment of therapy outcomes: Incorporating a qualitative study into a randomized controlled trial evaluating the treatment of adolescent depression, Beyond a diagnosis: The experience of depression among clinically-referred adolescents, Public knowledge and assessment of child mental health problems: Findings from the National Stigma Study-Children, Prevalence of mental health problems among children and adolescents in Germany: Results of the BELLA study within the National Health Interview and Examination Survey, Exploring professional help-seeking for mental disorders, Interpretative phenomenological analysis and the psychology of health and illness, The size and burden of mental disorders and other disorders of the brain in Europe 2010, International Journal of Qualitative Studies on Health and Well-being. Quotes exemplifying these issues are provided in Table 4. We could sense from the interviews that this in itself was again perceived as another failure and could add to their distress and possibly a sense of self-blame. However, the current sample showed high comorbidity with posttraumatic stress disorder, in which irritability is a core symptom as well. Many participants reported barriers to obtaining information about depression and its treatment. Furthermore, sleeping problems, difficulties concentrating, and, related to this, the negative impact on education were common in our sample, as has been found in other interview studies (Crowe et al., 2006; Farmer, 2002; Lachal et al., 2012; Midgley et al., 2015). This high level of suffering became clear through their frequent usage of words like “completely” or “extreme.” For example, Melissa described having “extreme problems concentrating,” before she went on to describe her current problems. . 1 Some see depression as independent of time, place, and culture; common in primary care; 2 and effectively managed there. In cases where they did not choose their own pseudonym, participants were assigned a pseudonym. I always suppressed it the whole time. The other researcher-interviewer (BGS) reviewed all the notes and coding for consistency and to ensure that no significant concepts or themes had been overlooked or statements misclassified or left uncoded. However, these seemed to be independent of and rather co-existing with the strong feeling of not knowing and not understanding. 2017;50(2):107-124. doi: 10.1159/000455256. 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. The three phases of qualitative research are summarized in Fig. In common with qualitative research on postnatal depression women spoke of a relationship between high expectations, perceived lack of competence as a mother and anxiety, loneliness and feeling overwhelmed. In particular, the YP reported feeling overwhelmed with the situation, struggling to make sense of what was going on for them, feeling isolated, and considering therapy as a last resort, with the notion that you have to deal with the depression yourself. The YP were all entering psychodynamic therapy, although only one of the YP seemed to have an understanding of different therapy approaches and wanted psychodynamic treatment specifically. 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. If not, what else would you have liked to know? For Shadow, this loss in performance had only been transient: Well, um, in school I completely deteriorated um in that period of time . The interview deliberately encourages the YP to describe their experiences in their own words. This study aimed to investigate the experience of depression in a German sample of YP. 1. We chose to retain and analyze interviews with participants reporting a diagnosis of bipolar disorder, because their reported experiences with depression diagnosis and treatment were quite similar to those of our participants not reporting a bipolar diagnosis, and depression is a common presentation of bipolar disorder. Similar aspects of isolation were also reported in Dundon’s meta-synthesis, like feeling different and not wanting to burden others (Dundon, 2006). SAGE Publications Inc, unless otherwise noted. There is a lack of research in health psychology on the subjective experience of adolescents with mental health disorders. Did you feel you had enough information to make a good choice? Participants frequently reported incidents of missed diagnosis during visits to PCPs. This in turn added to the sense of loneliness and isolation. 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). One full stop is the equivalent of one second. The accounts differ, however, in the way that the aggression is experienced, such as being rather diffuse or having a clear object (the YP themselves or close ones), as in the case of Lara who felt strong anger toward the abusive family member: Intense aggression . At the start of the interview, participants were asked again for their consent to audiotape and were reminded that they had the right to withdraw from the interview at any time and that questions did not have to be answered. Related to this, Bolton Oetzel and Scherer (2003) described adolescents as often not entering therapy on their own account, and rather being at a stage of pre-contemplative reluctance to change according to the transtheoretical model of behavior change (Prochaska & Norcross, 2001). 12. These could be grouped into several categories: lack of motivation due to depression, stigma of depression and/or denial of the diagnosis, practitioners seeming unresponsive, and a mismatch between their preferred mode of learning and how information was offered. Another important point is that we are still not doing enough to fight mental health stigmatization (Pescosolido et al., 2008). She called up a number of therapists who only put her on waiting lists and did not give her an initial appointment. 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, (.) For these YP without the experience of a caring parent, loneliness and isolation arose from this feeling of being left on one’s own. This might be illustrated by Melissa and Katrin who both had prior therapy experience in which parental divorce was discussed as a causal factor in their depression by the therapist; however, Melissa and Katrin both shared the experience that the divorce of their parents was not sufficient to explain their degree of suffering. Many persons diagnosed with depression do not commence treatment for it,9 and the majority of persons who do enter treatment do not receive their preferred type of treatment, even though this seems to lead to better outcomes.13,14 Furthermore, many persons starting treatment do not complete an adequate treatment course.15 The US Preventive Services Task Force “recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up” with a grade B recommendation,16 as such systems have been demonstrated to improve health status and, in some instances, to reduce health care costs.17–20, There is a remarkable paucity of information about patients’ understanding of depression and its treatment options, and the role patients play in choosing treatment options. This qualitative study provides rich data but the study is not designed to provide results that can be generalised to the broader populations of adolescents with depression. Sign In to Email Alerts with your Email Address. The different aspects will be discussed in turn. Did you learn about both counseling and medications? None remembered being given any explanation of what counseling options, such as cognitive-behavioral therapy, problem-solving therapy, and interpersonal therapy, might be like. All of them spoke about living with depression for a long time before they sought professional help. 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. carried out the first steps of IPA, the case analyses, and the developing of emerging themes separately. Given our a priori descriptive goals, we did not seek to generate new theories about depression in primary care; rather, we focused on describing common experiences and identifying gaps and barriers that might be amenable to interventions to improve depression care for future patients. I, um, miss out on school frequently, because, um, I have headaches (.) . The specific setting of a one-off meeting with a genuinely interested adult seemed to have facilitated the process. The 15 participants ranged in age from their mid-20s to their late 50s, with about half in their mid-40s, and were evenly split between males and females. 9. To add to the complexity of the experience of isolation, for Melissa, in particular, the lack of understanding of others was distressing. 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. In this view, research should focus on improving management through training doctors, providing public education, and reorganizing practice systems. Quantitative studies describe a bidirectional association between loneliness and depression, but there is limited understanding of how these influence each other. These 3 researchers then compared results and, through an interactive process of discussion, reflection, and scrutiny of the interview template, interview notes, and initial coding, arrived at consensus on a refined coding scheme. For more information view the SAGE Journals Sharing page. 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 aim of this study was to build on previous studies, by examining the lived experience of YP diagnosed with depression living in Germany, and additionally to look at the way these YP accessed therapy in the context of the German mental health system, including reported reasons for any treatment delay. More research is needed to study the dimensions and role of alternative masculinities in the context of depression. For each interview, K.W. 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. A superordinate theme was, for instance, “fear of stigmatization,” which incorporated the theme from Melissa mentioned above, but included also Melissa’s subordinate theme of “playing a role” or “hiding her suffering.” These steps are carried out for each of the transcripts separately. The aim of this study was to explore the experience of depression and the journey into therapy of young people (YP) diagnosed with depression. Our interview template did not have probes to clearly delineate the separate roles of primary care and mental health specialty care and the coordination of care between them. he would have never, never have expected that from me.”. At home I just said: “It’s okay, fine, I am fine.” (.) Results: Thirteen papers that considered mothers’ (n = 199) experiences of PPD were included in the review. They were between 15 and 19 years old, and five of them were female. The notion of trying to deal with it by themselves was closely linked to the theme of therapy as a last resort. These themes are grounded in the particularity of the interview (e.g., Melissa: “Expected negative reaction of friends”). well, if I was in a bad mood, then (.) 7. 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). The wide range of consequences discussed included adverse effects on others, difficulties coping with feeling out of control and loss of self-identity. Interviewers were education ( VV-N ) and is currently in training for cognitive behaviour therapy parents... Cross-Case themes West Midlands and the other interviewers were education ( VV-N ) and currently... Subjects currently undergoing treatment for depression generally involves, maybe not really forget, but this information to a. 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