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Crowe M, Manuel J, Carlyle D, Thwaites B, Lacey C. The experience of 'treatment-resistant' depression: A qualitative meta-synthesis. Int J Ment Health Nurs 2023; 32:662-672. [PMID: 36635921 DOI: 10.1111/inm.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/14/2023]
Abstract
While antidepressants may be effective in treating depression for some people, a third of people do not have an improvement in mood after a trial of two different antidepressants for an adequate duration. These people are diagnosed as having 'treatment-resistant' depression which situates the problem as part of their biological or psychological makeup. We conducted a search of studies that examined this problem from the perspective of people whose depression did not improve on antidepressants. Nine studies were included in a qualitative meta-synthesis that identified four themes across these studies: feeling trapped, disconnection, loss of self, and questioning. The participants experienced considerable distress associated with the constant presence of depression in their lives. While antidepressants may help some people, there is a need for more innovative approaches to the treatment of depression. There is a strong argument for trialling appropriate evidence-based psychotherapy before a person is categorized as having treatment-resistant depression. It is perhaps better to describe the issue as inadequate efficacy of antidepressants to situate the problem with the treatment provided rather than with the person.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Bridgette Thwaites
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Abstract
PURPOSE To illuminate long-term experiences of mental illness from both research and autobiographical accounts. DESIGN A literature review of English-language papers, 1950-2014, relating to the experience of long-term mental illness indexed in AgeInfo, AMED, ASSIA, British Nursing Index (BNI), CINAHL, MEDLINE, PsycEXTRA, and PsychINFO. FINDINGS Twenty-five research papers and nine autobiographic accounts met the review criteria. Thematic analysis revealed nine themes: fear, explanation seeking, stigma, disability, coping strategies, control, support, change and learning, and life history. Specific gaps of note relate to age differences, acknowledgement of longevity of mental illnesses, and different cultural perspectives. Research Implications: There is an absence of longitudinal studies focused on experiences of long-term mental illness. The considerable length-of-time implicated in the experiences suggests that more individual life experience rather than illness focused studies are needed, enabling a holistic understanding. This includes studies from cultures other than the Western world. Greater transparency is needed in justifying age inclusions or passive exclusion of older peoples' perspectives. PRACTICAL IMPLICATIONS Knowledge of long-term mental illness experiences is of great importance to mental health practitioners. Evidence-based services cannot be provided if we do not have an holistic understanding of long-term mental illness. Social Implications: This review questions our ability to provide effective support for those experiencing long-term mental illness, in particular older people and different cultural perspectives. ORIGINALITY/VALUE There appear to be no literature reviews that focus on the individual experience of long-term mental illness. It highlights the surprisingly small number of research studies available to inform mental health practitioners.
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Affiliation(s)
- Elizabeth Collier
- a University of Salford , School of Health & Society , Salford , United Kingdom
| | - Maria J Grant
- a University of Salford , School of Health & Society , Salford , United Kingdom
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Kaite CP, Karanikola MN, Vouzavali FJD, Koutroubas A, Merkouris A, Papathanassoglou EDE. The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study. BMC Psychiatry 2016; 16:343. [PMID: 27716117 PMCID: PMC5053043 DOI: 10.1186/s12888-016-1051-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/24/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way. METHODS A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews. RESULTS Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants. CONCLUSIONS The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.
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Affiliation(s)
- Charis P. Kaite
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus
| | - Maria N. Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus
| | - Foteini J. D. Vouzavali
- Department of Nursing, Vocational High School of Nurse Assistants & Laboratory Instructor, Technological Educational Institute of Athens, Cholargos, Athens, Greece
| | - Anna Koutroubas
- Children’s Hospital “A & P Kyriakou” Oncology Department, Athens, Greece
| | - Anastasios Merkouris
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus
| | - Elizabeth D. E. Papathanassoglou
- Faculty of Nursing, University of Alberta, 5–262 Edmonton Clinic Health Academy (ECHA), 11405-87th Ave., Edmonton, AB T6G 1C9 Canada
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Kaite CP, Karanikola M, Merkouris A, Papathanassoglou EDE. "An ongoing struggle with the self and illness": α meta-synthesis of the studies of the lived experience of severe mental illness. Arch Psychiatr Nurs 2015; 29:458-73. [PMID: 26577563 DOI: 10.1016/j.apnu.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/16/2015] [Accepted: 06/26/2015] [Indexed: 12/30/2022]
Abstract
The diverse experiences of severely mentally ill persons, most of the times, have not been taken into account, or integrated to the treatment procedures. This meta-synthesis aimed to examine what is like to live with severe mental illness narratives by employing a meta-ethnographic synthesis of seventeen published peer reviewed qualitative studies. Third order analysis revealed as core theme "An ongoing struggle for reconciliation with the self and the illness". Other themes included amongst others: loss of identity, pain of having had one's life stolen, being an outcast. The identification of the importance of the alterations of self-identity throughout the continuum of the severe mental disorder may be the focus of targeted psychosocial interventions.
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Affiliation(s)
- Charis P Kaite
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
| | - Maria Karanikola
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
| | - Anastasios Merkouris
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
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Danielsson L, Rosberg S. Depression embodied: an ambiguous striving against fading. Scand J Caring Sci 2014; 29:501-9. [DOI: 10.1111/scs.12182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Louise Danielsson
- Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); Gothenburg Sweden
| | - Susanne Rosberg
- Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); Gothenburg Sweden
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Holm AL, Lyberg A, Severinsson E. Living with stigma: depressed elderly persons' experiences of physical health problems. Nurs Res Pract 2014; 2014:527920. [PMID: 25013728 PMCID: PMC4074963 DOI: 10.1155/2014/527920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/25/2022] Open
Abstract
The aim of this paper is to deepen the understanding of depressed elderly persons' lived experiences of physical health problems. Individual in-depth interviews were conducted with 15 depressed elderly persons who suffer from physical health problems. A hermeneutic analysis was performed, yielding one main theme, living with stigma, and three themes: longing to be taken seriously, being uncertain about whether the pain is physical or mental, and a sense of living in a war zone. The second theme comprised two subthemes, feeling like a stranger and feeling dizzy, while the third had one subtheme: afraid of being helpless and dependent on others. Stigma deprives individuals of their dignity and reinforces destructive patterns of isolation and hopelessness. Nurses should provide information in a sensitive way and try to avoid diagnostic overshadowing. Effective training programmes and procedures need to be developed with more focus on how to handle depressive ill health and physical problems in older people.
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Affiliation(s)
- Anne Lise Holm
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
| | - Anne Lyberg
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
| | - Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
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Blomdahl C, Gunnarsson AB, Guregård S, Björklund A. A realist review of art therapy for clients with depression. ARTS IN PSYCHOTHERAPY 2013. [DOI: 10.1016/j.aip.2013.05.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zolnierek CD. Exploring lived experiences of persons with severe mental illness: a review of the literature. Issues Ment Health Nurs 2011; 32:46-72. [PMID: 21208053 DOI: 10.3109/01612840.2010.522755] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper describes a literature review concerning the use of phenomenology to explore the experiences of persons with severe mental illness. Data from 35 publications were abstracted and summarized. The congruence between philosophical underpinnings and methods are critiqued. Findings of individual studies are summarized and reveal desires for normalcy, social relationships, meaningful activities, and opportunities for involvement and participation in treatment. The experience of suffering demonstrated the grave effect of severe mental illness on the individual's life experience. Utilization of phenomenology as a philosophy and methodology can guide the development of interventions that honor individual experience and meaning.
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Ahlström BH, Skärsäter I, Danielson E. The meaning of major depression in family life: the viewpoint of the ill parent. J Clin Nurs 2010; 19:284-93. [PMID: 20500264 DOI: 10.1111/j.1365-2702.2009.02851.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE The aim was to elucidate the meaning of major depression in family life from the viewpoint of an ill parent. Background. Major depression according to Diagnostic and Statistical Manual of Mental Disorders is common and may appear repeatedly over several years, and affects family life. Depression in parents has a negative impact on family function and children's health; however, studies regarding the deeper understanding of major depression in family life are lacking. DESIGN A qualitative explorative study using narrative interviews with eight parents who were identified with major depression. METHODS A phenomenological-hermeneutic method of interpretation was used for analysing interview texts and included naïve understanding, a structural analysis where text was divided into meaning units, which were condensed and abstracted, and finally a comprehensive understanding. RESULT Two themes were extracted: 'to be afflicted in an almost unmanageable situation' with sub-themes 'feeling hopelessly bad', 'being worthless', 'being unsatisfied' and the theme 'to reconcile oneself to the situation' with sub-themes 'being active', 'being satisfied' and 'maintaining parenthood'. CONCLUSION Comprehensive understanding revealed the parents' simultaneous suffering and dignity in family life; suffering with serious lack of well-being and health, destroyed self-confidence and unhappiness, and dignity with strength, confidence and joy in children. The movement between suffering and dignity complicated family life. Dignity was threatened by the awareness that suffering in major depression was recurrent. Dignity had to be repeatedly restored for self and the family, and family dignity has to be restored before others outside the family circle. RELEVANCE TO CLINICAL PRACTICE A deeper understanding of the meaning of major depression in family life is helpful and for healthcare professionals to prevent individual and family suffering by assisting and preserving dignity.
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Affiliation(s)
- Britt Hedman Ahlström
- The Sahlgrenska Academy at Gothenburg University, Institute of Health and Care Sciences, Gothenburg, Sweden.
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Abstract
The goal of this study was to evaluate the content validity of the Depressive Symptom Assessment for Older Adults (DSA), an interviewer-rated instrument designed to comprehensively measure depression in older adults regardless of their cognitive status. Seniors who were not currently depressed but had been either previously depressed or had an older adult family member who was depressed (n = 7) served as content validation experts for this two phased study. In Phase 1 of the content validation process, 19 of the questions had 100% agreement, 20 of the questions had 86% agreement, 13 of the questions had 71% agreement, 5 of the questions had 57% agreement, and 2 of the questions had 43% agreement. In Phase 2 of the content validation process, 42 of the questions had 100% agreement, 11 of the questions had 86% agreement, and 1 of the questions had 71% agreement. The DSA provides mental health nurses with a comprehensive instrument to assess older adults for depression.
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Affiliation(s)
- Lisa L Onega
- Radford University, School of Nursing, Radford, Virginia 24142, USA.
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