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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depression is a very common mental illness within the general population and in-patients consulting in general practice. General practitioners are well placed to provide care for patients with mental health problems, as these disorders are often connected with family and social problems, and GPs can provide their patients with long-term follow-up and support. While there are theoretical reasons for the important role of the family doctor, there is limited evidence about how general practitioners view their roles and their capacity to cope with the mental health needs of their patients. This paper explores the experience of 15 general practitioners from Scotland, who were interviewed during the spring of 1998, about how they approached the care of patients with depression in relation to their skills, knowledge and attitudes. The following four key categories of interest are presented which underpin the emergent themes of the study: (1) organizational issues; (2) referral and the use of other professionals; (3) treatment and management issues; (4) stigma. These themes reveal some interesting issues in relation to GPs' recognition and management of depression and it is also clear that the perception of collaboration within primary care and between primary and secondary care is an integral part of the process. The implications of what has been learned from this study may include the development of educational opportunities for GP trainees and established principals, in addition to brief multidisciplinary training opportunities and shared learning events between primary and secondary care.
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PMID:Optimizing the care of patients with depression in primary care: the views of general practitioners. 1156 Jun 81

Although conventional antipsychotics are useful for the treatment of schizophrenia, many patients discontinue taking them within a few months. As well as the positive influence of a good doctor-patient relationship, evidence suggests that the patient's initial subjective experience during antipsychotic therapy is a major predictor of compliance. In addition to motor symptoms, conventional antipsychotics can cause significant adverse effects on drive, emotion and cognition, which are reflected in patients complaining of a reduced quality of life, although may not be detected by objective examination. This syndrome, which is similar to the negative symptoms of schizophrenia, is known by numerous terms including 'pharmacogenic depression' and 'pharmacogenic anhedonia'. The introduction of atypical antipsychotics broadened the criteria for effective antipsychotic treatment to include the subjective assessment of improvement in patients' quality of life. The previous lack of interest in this domain may have been due to the inability to improve it with conventional agents and the misconception that schizophrenic patients were unable to subjectively evaluate their quality of life. However, numerous studies have shown that 63-95% of patients in remission are able to self-rate their affective state of well being or quality of life. Atypical antipsychotics are superior to conventional antipsychotics in improving quality of life and reducing the stigma of schizophrenia, particularly from the patient's perspective and are strong reasons for the widespread use of these drugs.
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PMID:Good tolerability equals good results: the patient's perspective. 1158 86

Depression is a serious illness of which I and other patients should not be ashamed but this is hard to avoid. The stigma of depression is different from that of other mental illnesses and largely due to the negative nature of the illness that makes depressives seem unattractive and unreliable. Self stigmatisation makes patients shameful and secretive and can prevent proper treatment. It may also cause somatisation. A major contributing factor is that depression for those who have not had it is very hard to understand and so can be seen as a sign of weakness. Openness by depressives and education in schools could help.
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PMID:Stigma of depression--a personal view. 1171 20

An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV-related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people with HIV. Extraction of one higher-order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40-item instrument provided evidence of internal consistency reliability. The HIV Stigma Scale was reliable and valid with a large, diverse sample of people with HIV.
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PMID:Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. 1174 80

This paper reports the findings of a study investigating the smoking behaviours of a community-based psychiatric population. Using a qualitative, grounded theory approach, the four diagnostic categories of schizophrenia, bi-polar affective disorder, depression, and personality disorder were studied (24 interviews in total) in order to identify similarities and differences in smoking behaviours and perceptions of links between illness and cigarette smoking. A number of theoretical constructs emerged from the data, many of which confirm and enhance current understandings of issues, such as the role of cigarettes in managing the symptoms of illness. However, several themes not found in the existing literature also emerged. Smoking was found to play a significant existential role in the lives of participants: alleviating the effects of stigma, promoting positive and negative freedoms, and providing core needs as part of quality of life decisions. Perceptions of the nature and degree of interaction between psychiatric symptoms and the 'need' to smoke were also found to be significant. Variations in smoking between the different diagnostic groups were also found, in particular in the process of smoking itself the nature of the nicotine dependence as predominantly physical or psychological, attitudes towards the quitting process and sense of control, and the degree of significance of existential factors. The research findings suggest that we may be able to add new methods to our current ways of intervening to assist people with a mental illness who want to quit smoking. Differences in perceptions and patterns of use suggest that intervention may be more effective if psychiatric diagnosis is also taken into consideration. Because the paper is descriptive and hypothesis generating, its findings need to be tested using a larger sample.
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PMID:Smoking and quitting: a qualitative study with community-living psychiatric clients. 1182 Jun 84

The concept of cumulative adversity is a useful tool in the study of migration under chronic stress from past traumas. Drawing on this concept, the study explored long-term health and psychosocial effects of past radiation exposure among survivors of the Chernobyl nuclear disaster who immigrated to Israel during the 1990s. Self-rated health status and indicators of social adjustment were compared in two groups of Russian immigrants: 180 persons from Chernobyl-affected areas and 200 immigrants from other areas of the former USSR. The semi-structured questionnaire was administered by Russian-speaking sociology students and analyzed by both quantitative and qualitative methods. In line with earlier research, both the somatic and mental health of Chernobyl survivors were significantly worse than in other immigrants of the same gender and age; a significant share of reported health problems were probably psychosomatic. Depression, sense of stigma and cancer-related anxiety were more prevalent in the study group. Immigrants from contaminated areas tended to use more health services (both conventional and alternative), but were less satisfied with their quality and providers' attitude. The link between perceived health impairment and poorer social accommodation in the host country has been confirmed: Chernobyl-area immigrants experienced more severe occupational downgrading and were more disappointed with the results of their resettlement than other immigrants.
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PMID:Immigrants from Chernobyl-affected areas in Israel: the link between health and social adjustment. 1182 34

This study used Olshansky's (1962) concept of chronic sorrow to examine social support needs of 21 human immunodeficiency virus (HIV)-positive men and women in a southern U.S. city. The methods of inquiry consisted of narrative interviews and a quantitative assessment of depression (the Center of Epidemiological Studies on Depression [CES-D] Scale). This combined approach indicated that chronic sorrow in HIV-positive persons is related to illness, fear of death, poverty, and social isolation, especially for women with children. More than half of the subjects scored as depressed, with African American women scoring significantly higher than Caucasian men or women. Social isolation often resulted from the effects of stigma, as framed in Erving Goffman's theory of discredited identity. The women were likely to be stigmatized because of their association with "dirty sex," contagion, and moral threat in heterosexual communities. Most of the men had been protected from the worst effects of stigma because of their ties to the gay community and associated health networks. Based on these preliminary findings, stigma should be considered a marker of chronic depression in the HIV-positive, and support services should take account of the stigmatizing contexts of HIV-positive persons.
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PMID:Chronic sorrow in the HIV-positive patient: issues of race, gender, and social support. 1183 16

The recommended shift in paradigm for assessment and treatment of depression and anxiety in the primary care setting includes a more holistic medical care approach, one that pays attention to the patient's mental health status and her functional level of social role recovery in addition to symptom relief. Practice Guidelines of professional specialities should be expanded to include attention to initializing mental health care in primary care practice and parameters for early referral and, if indicated, later follow-up. Our medical education system, at all levels, needs to become considerably more inclusive of issues of aging, gender, and mental health. Ongoing attention must be given to the health care cost burden of under recognition and under treatment of anxiety and depression, alleviation of stigma, treatment to functional recovery, and alleviation of caregiver burden.
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PMID:Depression and anxiety in older women. 1185 59

Although considerable research has been conducted on women who are depressed, the actual experiences and voices of women have not been central to this research. Therefore little is known about how women make sense of depression as they live with and manage it in their daily lives. Our purposes in doing this study were to (1) examine how women experience and manage depression and treatment, and (2) investigate the core components of women's explanatory models of depression (including beliefs about etiology, onset of symptoms, pathophysiology, course of illness, and treatment needs). We interviewed 43 women living in a small city in Western Canada who had sought treatment within the previous five years. Data were analyzed using the constant comparison method of grounded theory. In this paper we will focus on the core concept, Keeping it Together, and its three supporting categories, (1) Taking Up a Biomedical Explanation for Depression, (2) Using the Biomedical Explanatory Model (BEM) to Manage the Stigma of Depression, and (3) The Inadvertent Effects of Adopting a BEM.
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PMID:Keeping it together: how women use the biomedical explanatory model to manage the stigma of depression. 1190 63

The formal beginnings of psycho-oncology date to the mid-1970s, when the stigma making the word "cancer" unspeakable was diminished to the point that the diagnosis could be revealed and the feelings of patients about their illness could be explored for the first time. However, a second stigma has contributed to the late development of interest in the psychological dimensions of cancer: negative attitudes attached to mental illness and psychological problems, even in the context of medical illness. It is important to understand these historical underpinnings because they continue to color contemporary attitudes and beliefs about cancer and its psychiatric comorbidity and psychosocial problems. Over the last quarter of the past century, psycho-oncology became a subspecialty of oncology with its own body of knowledge contributing to cancer care. In the new millennium, a significant base of literature, training programs, and a broad research agenda have evolved with applications at all points on the cancer continuum: behavioral research in changing lifestyle and habits to reduce cancer risk; study of behaviors and attitudes to ensure early detection; study of psychological issues related to genetic risk and testing; symptom control (anxiety, depression, delirium, pain, and fatigue) during active treatment; management of psychological sequelae in cancer survivors; and management of the psychological aspects of palliative and end-of-life care. Links between psychological and physiological domains of relevance to cancer risk and survival are being actively explored through psychoneuroimmunology. Research in these areas will occupy the research agenda for the first quarter of the new century. At the start of the third millennium, psycho-oncology has come of age as one of the youngest subspecialties of oncology, as one of the most clearly defined subspecialties of consultation-liaison psychiatry, and as an example of the value of a broad multidisciplinary application of the behavioral and social sciences.
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PMID:History of psycho-oncology: overcoming attitudinal and conceptual barriers. 1191 37


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