The meaning of major depression in family life: the viewpoint of the ill parent

Major Depression as a Disorder of the Narrative Self: A Qualitative Study

INTRODUCTION

Abnormal self-experiences are a common feature of major depression despite their absence from current diagnostic manuals. Current diagnostic criteria leave us with an impoverished conception of depressive disorders, and they fail to exploit the diverse experiential alterations that might be useful for understanding and diagnosing patients, and last but not least for explaining the aetiology of these disorders. Although some phenomenological descriptions of abnormal self-experiences in major depression are available, further research is needed to validate these through detailed clinical interviews.

METHODS

To characterize these phenomena in more detail and to verify and consolidate previous accounts, we conducted a qualitative study using the Consensual Qualitative Research method.

RESULTS

Our findings identified three categories of abnormal self-experiences: (1) impossibility to project oneself forward, (2) not recognizing one's self, and (3) losing control on one's self.

CONCLUSION

Before delving into these results, we briefly described how the self is conceptualized in phenomenological psychopathology and explored in the literature on the self-experience in major depression. After discussing our results in the light of recent and contemporary phenomenological literature, we suggest that the inability to recognize otherness as part of oneself - which is the core of depressive experiences - ends in specific symptoms of depersonalization that differ from schizophrenic ones. We conclude that the self-experience, and in particular narrative identity, is central to the development and maintenance of depression.

The lived experience of major and treatment-resistant depression in England: a mixed-methods study

INTRODUCTION

Major depressive disorder (MDD) is a common, frequently recurrent condition associated with decreased well-being and increased healthcare-related costs. Mixed-methods research provides multiple ways of illustrating the phenomenon to better understand patient experience, including where treatment is not working, referred to here as treatment-resistant depression (TRD).

METHODS

A mixed-methods study investigated the experiences of people with symptomatic MDD, symptomatic TRD or TRD in remission, surveying 148 adults recruited from English clinical sites to measure symptom severity (Patient Health Questionnaire-9 [PHQ-9]), HRQoL (EQ-5D-5L/World Health Organisation Brief Assessment of QoL [WHOQOL-BREF]) and work productivity/activity impairment (WPAI:D). Interviews with 26 survey respondents were analysed thematically. Integrated datasets explored areas of convergence and divergence, with concepts mapped against the EQ-5D-5L.

RESULTS

Qualitative data explained low WHOQOL-BREF domain scores and the interrelation of psychological, emotional, cognitive and physical difficulties. Tiredness, lack of energy and motivation impacted daily activities, socialising and career goals. Low work performance scores were explained by poor concentration, decision-making and motivation. Participants also described the influence of social support and housing insecurity. Only 19 % of HRQoL qualitative codes mapped to the EQ-5D-5L. Themes dominant in patients with TRD were inability to cope, self-care challenges, dissatisfaction with mental health services and treatment pessimism.

LIMITATIONS

Limited data collected on people with TRD in remission.

CONCLUSIONS

The EQ-5D-5L and WPAI:D likely underestimate how depression impacts the HRQoL and work of people with MDD or TRD. Qualitative data suggest increased distress for people with TRD compared to those with MDD. Clinical management and treatment access decisions should consider the broader impacts of depression and environmental factors affecting the patient's experience.

The lived experience of depression: a bottom-up review co-written by experts by experience and academics

We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.

Social dignity for marginalized people in public healthcare: an interpretive review and building blocks for a non-ideal theory

Jacobson (Social Science & Medicine 64:292-302, 2007) finds two distinct meanings of "dignity" in the literature on dignity and health: (1) intrinsic human dignity and (2) social dignity constituted through interactions with caregivers. Especially the latter has been central in empirical health research and warrants further exploration. This article focuses on the social dignity of people marginalized by mental illness, substance abuse and comparable conditions in extramural settings. 35 studies published between 2007 and 2017 have addressed this issue, most of them identifying norms for social dignity: civilized interactions, non-stigmatizing treatment, treatment as unique individuals, being taken seriously, maintaining a positive identity, experiencing independence, relating to others, and participating in daily life. We argue that these norms belong to ideal theory, whereas we agree with Robeyns (Social Theory and Practice 34:341-362, 2008) and others that improving practice is better served by non-ideal theory. Towards this end, we derive from the literature four building blocks for a non-ideal theory of dignity: (1) avoid violations of dignity rather than seeking to promote it; (2) dignity is not a goal to be reached; it requires ongoing effort; (3) promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and (4) dignity can be undermined by organizational and discursive constraints.

Association between parental depressive symptoms and impaired bonding with the infant

Impaired bonding with the infant is associated with maternal postpartum depression but has not been investigated extensively in fathers. The primary study aim was to evaluate associations between maternal and paternal depressive symptoms and impaired bonding with their infant. A secondary aim was to determine the associations between parents' marital problems and impaired bonding with the infant. The study is part of a population-based cohort project (UPPSAT) in Uppsala, Sweden. The Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks and 6 months postpartum and the Postpartum Bonding Questionnaire at 6 months postpartum were completed by 727 couples. The prevalence of impaired bonding was highest among couples in which both spouses had depressive symptoms. Impaired bonding was associated with higher EPDS scores in both mothers and fathers, as well as with experiencing a deteriorated marital relationship. The association between maternal and paternal impaired bonding and the mothers' and fathers' EPDS scores remained significant even after adjustment for relevant confounding factors. Depressive symptoms at 6 weeks postpartum are associated with impaired bonding with the infant at 6 months postpartum for both mothers and fathers. It is critical to screen for and prevent depressive symptoms in both parents during early parenthood.

Families living with chronic illness: beliefs about illness, family, and health care

Beliefs can be described as the lenses through which we view the world. With emerging illness, beliefs about the illness experience become important for nurses to understand to enhance well-being and healing. The aim of this study was to illuminate illness beliefs of families living with chronic illness. A qualitative design was chosen, including repeated narrative research interviews with seven Swedish families living with chronic illness. Hermeneutic analysis was used to interpret the transcribed family interviews. The result described beliefs in families, both within and across families. Both core beliefs and secondary beliefs about illness, family, and health care were revealed. Illness beliefs have importance for how families respond to and manage situations that arise from their encounters with illness. Nurses have to make space for and listen to families' stories of illness to become aware of what beliefs may support and encourage family well-being and healing. The Illness Beliefs Model provides a touchstone whereby nurses can distinguish both individual and shared beliefs within families living with chronic illness and provide ideas for family intervention if needed.

The significance of small things for dignity in psychiatric care

Background:

This study is based on the ontological assumption about human interdependence, and also on earlier research, which has shown that patients in psychiatric hospitals and their relatives experience suffering and indignity.

Aim:

The aim of this study is to explore the experience of patients and relatives regarding respect for dignity following admission to a psychiatric unit.

Research design:

The methodological approach is a phenomenological hermeneutic method.

Participants and research context:

This study is based on qualitative interviews conducted with six patients at a psychiatric hospital and five relatives of patients who experienced psychosis.

Ethical consideration:

Permission was given by the Regional Committee for Medical Research Ethics in Western Norway, the Norwegian Data Protection Agency and all wards within the hospital in which the patients were interviewed.

Findings:

The analysis revealed one main theme: ‘The significance of small things for experiencing dignity’ and four subthemes described as follows - ‘to be conscious of small things’, ‘being conscious of what one says’, ‘being met’ and ‘to be aware of personal chemistry’.

Discussion and conclusion:

Staff members seem not to give enough attention to the importance of these small things. Staff members need to explore this phenomenon systematically and expand their own understanding of it.

Suporte familiar, crenças irracionais e sintomatologia depressiva em estudantes universitários

Este estudo teve como objetivo verificar as relações entre suporte familiar, sintomatologia depressiva e crenças irracionais. Participaram do estudo 377 voluntários de uma universidade do Estado de São Paulo, com idade média de 20,69 anos (DP= 2,29) e prevalência do sexo feminino (68,2%), que responderam ao Inventário de Percepção de Suporte Familiar - IPSF, o Inventário de Depressão de Beck - BDI e a Escala de Crenças Irracionais - ECI. Os resultados indicaram correlações entre o IPSF com o BDI e o ECI, indicando que, quanto maior a percepção de suporte familiar, menores são os escores de sintomas depressivos e de crenças irracionais. Correlações entre BDI e ECI também foram encontradas, indicando que, quanto maior o número de crenças irracionais, maiores os sintomas depressivos, o que vai ao encontro dos dados da literatura.