| 404 |
| 274 |
| 404 |
| 433 |
| 3 |
| 23 |
| 44 |
| 69 |
| 363 |
| 386 |
| 405 |
| 444 |
| 467 |
| 492 |
| 510 |
| 533 |
| 93 |
| 13 |
| 42 |
| 163 |
| 187 |
| 275 |
| 298 |
| 322 |
| 340 |
| 554 |
| 586 |
| 604 |
| 624 |
| 642 |
| 673 |
| 680 |
| 700 |
Available online 12 January 2006.
| Referred to by: |  | A sensible 10-year plan for mental health The Lancet, Volume 367, Issue 9505, 14 January 2006-20 January 2006, Page 86, The Lancet  PDF (85 K) |
Summary
In this review of the last 5 years' developments in research into depression we focus on recent advances and current controversies. We cover epidemiology and basic science as well as the treatment of depression in adults in all its forms. Depression in childhood and adolescence, as well as in old age has been covered in recent Seminars in The Lancet. Depression in adulthood remains a very common and under-treated condition, resulting in a high degree of disability. Increasingly detailed knowledge about impairment of information processing in depression is being supplemented by quantitative studies of the brain processes underlying these impairments. Most patients improve with present treatments. The mechanisms of action of antidepressants are not fully understood; the hypothesis that reversing hippocampal cell loss in depression may be their active principle is a fascinating new development. Moral panic about the claim that antidepressant serotonin reuptake inhibitors cause patients to commit suicide and become addicted to their medication may have disconcerted the public and members of the medical profession. We will try to describe the considerable effort that has gone into collecting evidence to enlighten this debate.
Left off p. 21 of Google Scholar. Don't need any more I think - all the same kind of neurochemical stuff.
Epidemic of child/adolescent depression? http://devepi.duhs.duke.edu/library/pdf/20208.pdf
The soul of sorrow work
Rockyview General Hospital
The courage and willingness to walk alongside families in grief calls forth particular beliefs and practices in nurses and other health care professionals. In this second phase of a study on grief and grief interventions, the researchers examine experiences of bereaved family members who received care in a grief support program and explore program clinicians'explanations of the work that they do with the bereaved. Findings of this interpretive study suggest that it is not so much models of grief intervention but maps that most guide the clinicians—maps that are drawn out of experience and with awareness of their limitations. The family members and the clinicians bring us to an understanding that, often, it is the willingness to step off of the map that makes for the best traveling companion in the spiritual walk of grief.
Key Words: grief • hermeneutic inquiry • grief interventions • family bereavement • spirituality
Journal of Family Nursing, Vol. 13, No. 1, 117-141 (2007)
http://jfn.sagepub.com/cgi/content/abstract/13/1/117
______
Review of Loss of Sadness
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660154/
______________________________________
Physicians' constructions of depression: inside/outside the boundaries of medicalization.
University of Saskatchewan, Canada.
A qualitative study explored primary care physicians' experiences of diagnosing and treating depression. Twenty physicians participated in semi-structured interviews. Interview questions asked physicians to consider a range of topics such as the etiology of depression, the diagnostic process and treatment of depression. Transcripts were analyzed discursively with a view to exploring the ways in which physicians construct depression. In this article, physicians' constructions of depression are examined through exploration of their descriptions of this condition, as well as their recognition of the social context of depression. Based on this analysis, it was concluded that physicians' medicalized understandings of depression conflict with recognition of the social context of depression. The result of this conflict is dissonant descriptions of depression. One implication of this research is that physicians' training would benefit from the integration of multidisciplinary perspectives on depression, which would better reflect physicians' experiences in routine practice situations.
Diagnosing depression: there is no blood test.
Department of Sociology, University of Saskatchewan, Saskatoon, SK. Roanne.Thomas@usask.ca
OBJECTIVE: To explore and describe primary care physicians' experiences in providing care to depressed patients and to increase understanding of the possibilities and constraints around diagnosing and treating depression in primary care. DESIGN: Qualitative study using personal interviews. SETTING: A hospital region in eastern Canada. PARTICIPANTS: A purposely diverse sample of 20 physicians chosen from among all 100 practising family physicians in the region. METHOD: Invitations were mailed to all physicians practising in the region. Twenty physicians were chosen from among the 39 physicians responding positively to the invitation. Location of practice, sex, and year of graduation from medical school were used as sampling criteria. The 20 physicians were then interviewed, and the interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative approach involving handwritten notes on transcripts and themes created using qualitative data analysis software. MAIN FINDINGS: Three themes related to diagnosis emerged. The first concerns use of checklists. Physicians said they needed an efficient but effective means of diagnosing depression and often used diagnostic aids, such as checklists. Some physicians, however, were reluctant to use such aids. The second theme, interpersonal processes, involved the investment of time needed for diagnosing depression and the importance of establishing rapport. The final theme, intuition, revealed how some physicians relied on "gut sense" and years of experience to make a diagnosis. CONCLUSION: Diagnosis of depression by primary care physicians involves a series of often complicated negotiations with patients. Such negotiations require expertise gained through experience, yet prior research has not recognized the intricacies of this diagnostic process. Our findings suggest that future research must recognize the complex and multidisciplinary nature of physicians' approaches to diagnosis of depression in order to better reflect how they practise.
Managing depression in primary care: another example of the inverse care law?
School of Primary Care, University of Manchester M14 5NP. cchew@man.ac.uk
BACKGROUND: Depression is a common problem, often being recurrent or becoming chronic. The National Service Framework for Mental Health (published by the Department of Health, 1999) states that people with depression should continue to be predominantly managed in primary care. There is much evidence that the detection and management of depression by GPs could be improved, but little work has focused on GPs' views of their work with depressed patients. OBJECTIVES: This was a qualitative study exploring GP attitudes to the management of patients with depression. Views of GPs in socio-economically deprived areas are compared with those serving more affluent populations. METHODS: Semi-structured interviews were conducted with two groups of GPs in north-west England. One group of GPs (22) were practising in inner-city areas, and a second group (13) in suburban and semi-rural practices. All were Principals in practices that participated in undergraduate teaching. The interviews were audio-taped and subsequently transcribed verbatim. Analysis was by constant comparison until category saturation of each theme was achieved. RESULTS: Subjects conceptualized depression as an everyday problem of practice, rather than as an objective diagnostic category. Thematic coding of their accounts suggests a tension between three kinds of views of depressed people: (i) That depression is a common and normal response to life events or change and that it reflects the medicalization of these conditions; (ii) That the label or diagnosis of depression offers a degree of secondary gain to both patients and doctors, particularly to those GPs practising in inner-city areas and (iii) That inner-city GPs experienced on-going management of depressed people as an interactional problem, in contrast to those GPs serving a less deprived population who saw depression as a treatable illness and as rewarding work for the GP. CONCLUSION: Depression is commonly presented to GPs who feel that the diagnosis often involves the separation of a normal reaction to environment and true illness. For those patients living in socio-economically deprived environments, the problems, and therefore the depression, are seen to be insoluble. This has an important implication for the construction of educational interventions around improving the recognition and treatment of depression in primary care: some doctors may be reluctant to recognize and respond to such patients in depth because of the much wider structural and social factors that we have suggested in this paper. That it is the doctors working with deprived populations who express these views, means that the 'Inverse care law' [Tudor Hart J. The inverse care Law. Lancet 1971; 1(7696): 405-412] operates in the management of depression.
PMID: 12429666 [PubMed - indexed for MEDLINE]
Struck by lightning or slowly suffocating - gendered trajectories into depression.
Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden. ulla.danielsson@fammed.umu.se
BACKGROUND: In family practice depression is a common mental health problem and one with marked gender differences; women are diagnosed as depressed twice as often as men. A more comprehensive explanatory model of depression that can give an understanding of, and tools for changing, this gender difference is called for. This study explores how primary care patients experience, understand and explain their depression. METHODS: Twenty men and women of varying ages and socioeconomic backgrounds diagnosed with depression according to ICD-10 were interviewed in-depth. Data were assessed and analyzed using Grounded Theory. RESULTS: The core category that emerged from analysis was "Gendered trajectories into depression". Thereto, four categories were identified - "Struck by lightning", "Nagging darkness", "Blackout" and "Slowly suffocating" - and presented as symbolic illness narratives that showed gendered patterns. Most of the men in our study considered that their bodies were suddenly "struck" by external circumstances beyond their control. The stories of study women were more diverse, reflecting all four illness narratives. However, the dominant pattern was that women thought that their depression emanated from internal factors, from their own personality or ways of handling life. The women were more preoccupied with shame and guilt, and conveyed a greater sense of personal responsibility and concern with relationships. CONCLUSION: Recognizing gendered narratives of illness in clinical consultation may have a salutary potential, making more visible depression among men while relieving self-blame among women, and thereby encouraging the development of healthier practices of how to be a man or a woman.
PMID: 19671133 [PubMed - indexed for MEDLINE]
Complexity of GPs' explanations about mental health problems: development, reliability, and validity of a measure.
Camden and Islington Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London. j.cape@ucl.ac.uk
BACKGROUND: How GPs understand mental health problems determines their treatment choices; however, measures describing GPs' thinking about such problems are not currently available. AIM: To develop a measure of the complexity of GP explanations of common mental health problems and to pilot its reliability and validity. DESIGN OF STUDY: A qualitative development of the measure, followed by inter-rater reliability and validation pilot studies. SETTING: General practices in North London. METHOD: Vignettes of simulated consultations with patients with mental health problems were videotaped, and an anchored measure of complexity of psychosocial explanation in response to these vignettes was developed. Six GPs, four psychologists, and two lay people viewed the vignettes. Their responses were rated for complexity, both using the anchored measure and independently by two experts in primary care mental health. In a second reliability and revalidation study, responses of 50 GPs to two vignettes were rated for complexity. The GPs also completed a questionnaire to determine their interest and training in mental health, and they completed the Depression Attitudes Questionnaire. RESULTS: Inter-rater reliability of the measure of complexity of explanation in both pilot studies was satisfactory (intraclass correlation coefficient = 0.78 and 0.72). The measure correlated with expert opinion as to what constitutes a complex explanation, and the responses of psychologists, GPs, and lay people differed in measured complexity. GPs with higher complexity scores had greater interest, more training in mental health, and more positive attitudes to depression. CONCLUSION: Results suggest that the complexity of GPs' psychosocial explanations about common mental health problems can be reliably and validly assessed by this new standardised measure.
This is interesting -f ar from compassion fatigue....
MRC Social & Public Health Sciences Unit, Glasgow, UK. C.Emslie@sphsu.mrc.ac.uk BACKGROUND: It is argued that the ways in which women express emotional distress mean that they are more likely to be diagnosed with depression, while men's relative lack of articulacy means their depression is hidden. This may have consequences for communicating with health professionals. The purpose of this analysis was to explore how men and women with depression articulate their emotional distress, and examine whether there are gender differences or similarities in the strategies that respondents found useful when engaging with health professionals. METHODS: In-depth qualitative interviews with 22 women and 16 men in the UK who identified themselves as having had depression, recruited through general practitioners, psychiatrists and support groups. RESULTS: We found gender similarities and gender differences in our sample. Both men and women found it difficult to recognise and articulate mental health problems and this had consequences for their ability to communicate with health professionals. Key gender differences noted were that men tended to value skills which helped them to talk while women valued listening skills in health professionals, and that men emphasised the importance of getting practical results from talking therapies in their narratives, as opposed to other forms of therapy which they conceptualised as 'just talking'. We also found diversity among women and among men; some respondents valued a close personal relationship with health professionals, while others felt that this personal relationship was a barrier to communication and preferred 'talking to a stranger'. CONCLUSION: Our findings suggest that there is not a straightforward relationship between gender and engagement with health professionals for people with depression. Health professionals need to be sensitive to patients who have difficulties in expressing emotional distress and critical of gender stereotypes which suggest that women invariably find it easy to express emotional distress and men invariably find it difficult. In addition it is important to recognise that, for a minority of patients, a personal relationship with health professionals can act as a barrier to the disclosure of emotional distress. ________________________ Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. BACKGROUND: Despite the fact that more than half of depressed persons are treated for this disorder by primary care physicians, depression is often under-recognized or treated inadequately. There is continued emphasis on effective treatment of depression in primary care patients, but little attention has been paid to the role of the depressed person's illness cognitions in coping with this disorder. Given the often recurring and chronic nature of depression, the individual's self-management strategies may be critical to effective treatment, recovery and remaining well. OBJECTIVES: The purpose of this pilot study was to determine whether primary care patients' personal illness cognitions for depression are associated with depression coping strategies and treatment-related behaviour. METHODS: Forty-one primary care patients with depressive symptoms or disorder completed interviews and questionnaires assessing illness cognitions for depression, depression coping strategies and other treatment-related behaviour. Descriptive statistics are used to present patients' illness cognitions for depression. t-tests and correlational analyses were completed to assess the relationship between illness cognitions, depression coping strategies and treatment-related behaviour. RESULTS: Preliminary data describing illness cognitions for depression are presented. Participants' illness cognitions for depression were significantly associated with current and past treatment-seeking behaviour, medication adherence and coping strategies. CONCLUSIONS: Although preliminary, these findings indicate that patients' understanding of depression and its consequences are associated with how they manage this illness. Future research is needed to examine the mediating and moderating effects of illness cognitions for depression on medication adherence and other self-management behaviours of depressed primary care patients. Knowledge about primary care patients' personal illness models will aid in the development of adherence interventions, self-management training and support services appropriate to patients' needs in the primary care setting. ___________________________________________ Youth Health Centre, Umeå, Sweden. ulla.danielsson@vll.se OBJECTIVE: To explore depression from a gender perspective, by capturing depressed women's and men's formulations of their experiences and understanding of their situation. DESIGN: Qualitative interview study. SETTING: A healthcare centre in northern Sweden. SUBJECTS: Eighteen patients who had been diagnosed with depression and treated for at least 6 months were interviewed in depth, both women and men of different ages and social status. Open questions were posed around the themes of Malterud's key questions, focusing especially on how the informants conveyed their experiences. Interviewing and qualitative data analysis went on simultaneously. RESULTS: The experience of depression held similarities for men and women, but the outward manifestations differed by gender as well as socioeconomic status. Though experiences of high demands underlay the narratives of all informants, home or work had different priority. Men talked more easily about physical distress--often the heart--than about emotions. Women verbalized more readily emotional distress--shame and guilt--while physical symptoms often revolved around the stomach. Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement. CONCLUSION. As clinicians we must listen attentively not only to the manifest but to the avoided or unarticulated. By doing so we might counteract normative gender patterns that highlight the depression of women and conceal that of men. MRC Social and Public Health Sciences Unit, Glasgow, UK. ecarol@msoc.mrc.gla.ac.uk There is evidence that depressive symptoms in men are often undiagnosed and untreated. It has been suggested that men may find it difficult to seek help because culturally dominant (or hegemonic) forms of masculinity are characterised by emotional control and a lack of vulnerability, while depression is often associated with powerlessness and the uncontrolled expression of emotion. However, very little research exists which examines men's experiences of depression. We analysed 16 in-depth interviews with a wide range of men with depression in the UK Our analysis explored associations between depression and men's gender identities. We found that, as part of recovery from depression, it was important for men to reconstruct a valued sense of themselves and their own masculinity. The most common strategy was to incorporate values associated with hegemonic masculinity into narratives (being 'one of the boys', re-establishing control, and responsibility to others). While this strategy could aid recovery, there was also evidence that the pressures of conforming to the standards of hegemonic masculinity could contribute to suicidal behaviour. In contrast, a minority of men had found ways of being masculine which were outside hegemonic discourses. They emphasised their creativity, sensitivity and intelligence, explicitly reflected on different models of masculinity and redefined their 'difference' as a positive feature. Our research demonstrates that it is possible to locate men who can, and will, talk about depression and their feelings; thus generalisations about depressed men always being silent are misleading. While some men will have the resources to construct identities that resist culturally dominant definitions of masculinity, many others will find it more useful (and perhaps less threatening) to re-interpret potentially feminising experiences as 'masculine'. Health professionals need to be aware of the issues raised by men's narratives which emphasise control, strength and responsibility to others. http://www.ncbi.nlm.nih.gov/sites/entrezPrinter-friendly version The Experience of Chronic Sorrow in African American Caregivers of Children With Sickle Cell Disease
Conference Sponsor: Sigma Theta Tau International Conference Year: 2005 Sickle Cell Disease (SCD) is a potentially life threatening disease prominent in the African American population which places heavy demands on caregivers. The psychological stressors and unpredictable nature of SCD gives rise to a variety of emotions. One such emotion is that of chronic sorrow. Studies addressing the phenomenon in the African American population is non existent. Therefore, the purposes of this study were to examine the process of chronic sorrow in caregivers of children with SCD, identify the characteristics of chronic sorrow and generate a substantive theory of chronic sorrow. Data suggested these caregivers moved through three overlapping stages: 1) learning about and incorporating the disease into their daily lives, 2) experiencing the sorrow and 3) ôdoing what you have to do and moving onö. A process of re-patterning began as caregivers learned to live with the unpredictable consequences of SCD. As a result of the process of re-patterning, caregivers learned that although they had no control over the disease and its outcomes, they did have control over their reactions and responses. The re-patterning behaviors enabled caregivers to ôdo what you have to do and move on.ö Nurses can utilize the findings of this study to prepare caregivers of children with chronic illness about the phenomenon of chronic sorrow and assist families with adjustment. Education and research can benefit from the findings of this study by include expanding the research to other disease processes, settings and populations.
http://nursinglibrary.org/Portal/main.aspx?pageid=4024&pid=7189
BEYOND EMPATHY - FROM A NURSING JOURNAL
http://www.journalofadvancednursing.com/docs/jan_1991.pdf
LEFT OFF "SORROW" ON GOOGLE SCHOLAR p. 16 - useless afte rthat even before as well...
_________________________________Exploring men's and women's experiences of depression and engagement with health professionals: more similarities than differences? A qualitative interview study.
Primary care patients' personal illness models for depression: a preliminary investigation.
Beyond weeping and crying: a gender analysis of expressions of depression.
Men's accounts of depression: reconstructing or resisting hegemonic masculinity?
Initiation: the living reality of an archetype
By Thomas Kirsch, Virginia Beane Rutter, Thomas SingerBook overview
No comments:
Post a Comment