Helpful Factors in the Treatment of Depression from the Patient's, Carer's and Professional's Perspective: A Concept Map Study.

OBJECTIVE: Depression research has resulted in knowledge about neurobiology, pharmacological strategies and short-term cost-effective treatments. However, more than two-thirds of all depressed patients experience insufficient improvement. Therefore, a better understanding of what patients, carers and professionals perceive as most helpful in the treatment of depression is needed. METHODS: Concept mapping, a mixed-method design, was used to identify the patients (n = 33), carers (n = 22) and professionals (n = 50) perspectives. In six brainstorm sessions, the patients, carers and professionals generated 795 ideas, which were condensed into 55 unique statements. Subsequently, 100 participants prioritized and sorted these statements, which were analysed by multidimensional scaling and cluster analysis and visualized as a two-dimensional map. RESULTS: The 55 statements were clustered in 10 factors and further grouped into four main-factors (meta-clusters): 'Professional therapist', 'Treatment content', 'Structured treatment process' and 'Treatment organisation'. Patients and carers prioritized 'Treatment organisation' higher than professionals, but overall there was considerable agreement about the factors of treatment the participants perceived as most helpful including factors related to the therapeutic relationship and the 'creation of hope'. CONCLUSIONS: Our study identified factors of depression treatment perceived as helpful according to patients, carers and professionals. Findings suggest that in a scientific era with emphasis on biological psychiatry, not only patients and carers, but also professionals consider aspecific factors the most helpful. Further studies might show that factors we found to be helpful in the treatment for depression, can be generalized to mental health treatment in general.

Patients' perspective on self-management in the recovery from depression.

BACKGROUND: Self-management appears to be a promising approach in the case of depression, which helps to stimulate patients' autonomy. However, a good and systematic description of the concept self-management from the patients' perspective, to our knowledge, has not yet been performed. OBJECTIVE: To determine: (i) what strategies patients think they can use themselves to recover from depression, (ii) which main themes of self-management strategies can be detected, and (iii) which of these strategies patients perceive as being most helpful. METHODS: We used concept mapping to explore the experiences of patients who recently recovered from a depressive episode. Patients generated self-management strategies in focus group discussions. The strategies were clustered on a two-dimensional concept map by a hierarchical cluster analysis. RESULTS: Patients generated 50 strategies that formed eight clusters: (i) proactive attitude towards depression and treatment, (ii) daily life strategies and rules, (iii) explanation of disease to others, (iv) remaining socially engaged, (v) engaging in activities, (vi) structured attention to oneself, (vii) contact with fellow sufferers, and (viii) other. Behavioural and cognitive strategies and a proactive attitude towards treatment were considered as the most helpful. DISCUSSION AND CONCLUSION: From the patients' perspective, there is a wide range of self-management strategies that they can use - and perceive as helpful- to contribute to their own recovery. Professionals could encourage patients to take an active role in achieving recovery. Further research could open new roads to improve patients' active contributions to current treatments for depression.

[Patients' perspective on self-management during recovery from depression]. / Het patiëntenperspectief op zelfmanagement in het herstel van depressie.

OBJECTIVE: To investigate what patients themselves think they can contribute to recovery from depression, and what they find to be effective. The patients' perspective is necessary to improve treatment for depression. DESIGN: Qualitative, hypothesis-generating study. METHOD: The experiences and opinions of 20 patients who had recently recovered from a depressive episode were investigated using the 'concept mapping' method. In the first stage, patients generated statements during group discussions around the question: 'What can people themselves do to recover from depression?' In the second stage, patients individually graded the statements by relevance and grouped them by common characteristics. In the third stage, the statements were analysed and positioned in a concept map. RESULTS: In the first stage, the patients generated 50 statements which could be grouped into the following 8 clusters: active attitude towards depression and the assistance offered, regimen, explanation of the disease to acquaintances, social contacts, undertaking activities, structured attention for yourself, contact with fellow sufferers, and others. The common factor in statements that patients found the most important was that the focus for recovery should be on oneself. CONCLUSION: From the patients' perspective several methods were mentioned by which patients can contribute to their own recovery from depression. Practitioners could use these in their contact with the patient during treatment. This study also provides the basis for developing a self-management module for recovery from depression.