Article Review on Depression

The topic is dysthymia. The qualitative study titled: “The self-management of longer-term depression: learning from the patient, a qualitative study”, investigates how people deal long-term with depression. The first page gives readers a brief background on depression and how it is viewed now as a long-term or chronic mental health problem (Chambers et al., 2015). Because more than half of people may suffer from at least one episode of depression after the first episode, it is important to understand how to manage depression in the long-term. “More than 50 % of people will have at least one further episode of depression after their first, and therefore it requires long-term management. However, little is known about the effectiveness of self-management in depression, in particular from patients’ perspective” (Chambers et al., 2015, p. 1).
The researchers created a study to understand what coping strategies people with long-term depression have and what options may be out there to help support self-management of the condition seeing as self-management seems to be the most common option for those with dysthymia. The qualitative study took the form of semi-structured interviews where the researchers had in-depth interviews with twenty-one participants. The results were analyzed under interpretative phenomenological analysis. Deriving meaning from the answers and then putting them under themes helps researchers using a qualitative approach understand from varied perspectives what may work and what does not regarding long-term depression.
The results demonstrated four super-ordinate themes along with various prominent sub-themes. “experience of depression, the self, the wider environment, self-management strategies…hope, confidence and motivation could be powerful agents; and how engaging in a wide range of chosen activities could contribute to their emotional, mental, physical, social, spiritual and creative wellbeing” (Chambers et al., 2015, p. 1). These themes and sub-themes help provide a clearer picture of what can be done to support self-management. Self-management relies on the hope of being able to overcome the illness, the motivation to continue doing the right things for the self, and providing one’s self with outlets to express one’s self emotionally, spiritually, and so forth.
Interestingly, the answers from the participants demonstrated that support services were not necessarily useful towards self-management. Individualized holistic models were favored among participants as they wanted more control and choice over how they managed their long-term depression. First episodes of depression were different for participants however, as then they would have wanted resources and strategies to cope with the mental illness. However, past the first episode, when it becomes a long-term problem, participants wanted more in terms of self-management strategies rather than support services.
The article provided a key understanding of what people with long-term depression need. The key themes and feelings of control and choice along with hope and motivation illuminate the possibility of improving treatment for people with dysthymia. Self-management is a crucial aspect of long-term care for patients with dysthymia. They need the support during the first episode of depression, and then knowledge on how to deal with depression on their own if it continues past the first episode. Because the qualitative study had so few participants (21), it does not provide an adequate understanding of what people suffering with dysthymia require in the long-term. However, it did provide some basis to help guide research in the future.
Some problems the study had lay in participant recruitment. There were a few participants able to complete the interviews. Before that was a brief screening questionnaire that offered information regarding the participant’s experience of depression, demographics, and service use (Chambers et al., 2015). Part of the exclusion criteria included people not living in South Yorkshire, creating an ethical problem in that, people regionally may have varying experiences when it comes to mental health.
Culturally speaking, there are also key differences that could increase or decrease the likelihood of depression (Klein & Kotov, 2016). It is also important to consider sociodemographic correlates. “A number of sociodemographic correlates of major depression are found consistently across countries, and cross-national data also document associations with numerous adverse outcomes, including difficulties in role transitions” (Kessler & Bromet, 2013, p. 119). By simply choosing people from one area of the region to interview, the mind mapping they did could be less robust. Additionally, by adding the use of focus groups, the researchers had the potential ethical problem of people becoming aware within the study of what others believed and so forth. Privacy and anonymity are often important in studies. However, the inclusion of focus groups removed some of that to a certain extent.
The researchers did engage in reflexivity allowing for a further enhancement of the study. They engaged in reflective exercises before conducting interviews. They also maintained research diaries to further reflect on the time spent with participants and their answers. They also all wrote (the research members), a short reflexive piece to highlight specific issues encountered during the study and were of importance to them. This was an important aspect of the study as it showed the need to properly absorb the information collected from the interviews and focus groups.
Because the interviews were in-depth, there was use of focus groups, and reflexivity exercises, it did help to remove or address some of the potential biases. However, it would have been helpful to see how other similar studies did and if their results matched or were similar to theirs. Overall, the qualitative study did well in analyzing the information of the participants in a meaningful way.
References
Chambers, E., Cook, S., Thake, A., Foster, A., Shaw, S., Hutten, R., … Ricketts, T. (2015). The self-management of longer-term depression: learning from the patient, a qualitative study. BMC Psychiatry, 15(1), 1-12. doi:10.1186/s12888-015-0550-6
Kessler, R. C., & Bromet, E. J. (2013). The Epidemiology of Depression Across Cultures. Annual Review of Public Health, 34(1), 119-138. doi:10.1146/annurev-publhealth-031912-114409
Klein, D. N., & Kotov, R. (2016). Course of depression in a 10-year prospective study: Evidence for qualitatively distinct subgroups. Journal of Abnormal Psychology, 125(3), 337-348. doi:10.1037/abn0000147