Diagnostic accuracy and treatment approach to depression in primary care: predictive factors

Effectiveness of narrative nursing on depression patients with suicide attempt: A preliminary randomized controlled trial

BACKGROUND AND OBJECTIVES

Suicidal behavior, encompassing both suicidal ideation and attempts, is a common symptom among individuals with depression, significantly contributing to the overall burden of the illness. This study aimed to develop a narrative nursing method based on the Three-Step Theory of Suicide and applied this method to explore its preliminary effectiveness in depression patients with suicide attempts.

METHODS

50 patients with depression and high suicide ideation were randomly allocated to two groups: an intervention group, which received narrative nursing based on the Three-Step Theory of Suicide alongside usual nursing, and a control group, which received only usual nursing. The differences in depression levels, drug attitudes, and suicidal ideation were compared between the two groups both before and after the intervention. This study has been officially registered in the China Clinical Trial Registry (Registration No. ChiCTR2300079100).

RESULTS

A total of 50 patients were enrolled in this study, with 25 patients in the intervention group and 25 patients in the control group. 6 participants were lost to follow-up in the intervention group, and 4 participants were lost to follow-up in the control group. After the intervention, the intervention group showed significant effectiveness compared to the control group in the score of depression, drug attitude and idea of suicide.

CONCLUSIONS

Narrative nursing base on Three-Step Theory of Suicide could relieve depression, improve drug attitudes, thereby enhancing medication and treatment adherence, and alleviate suicidal ideation. Therefore, the method could be further applied to explore long-term effects.

Online Depression Communities as a Complementary Approach to Improving the Attitudes of Patients With Depression Toward Medication Adherence: Cross-Sectional Survey Study

BACKGROUND

Lack of adherence to prescribed medication is common among patients with depression in China, posing serious challenges to the health care system. Online health communities have been found to be effective in enhancing patient compliance. However, empirical evidence supporting this effect in the context of depression treatment is absent, and the influence of online health community content on patients' attitudes toward medication adherence is also underexplored.

OBJECTIVE

This study aims to explore whether online depression communities (ODCs) can help ameliorate the problem of poor medication taking among patients with depression. Drawing on the stimulus-organism-response and feelings-as-information theories, we established a research model to examine the influence of useful institution-generated content (IGC) and positive user-generated content (UGC) on attitudes toward medication adherence when combined with the mediating role of perceived social support, perceived value of antidepressants, and the moderating role of hopelessness.

METHODS

A cross-sectional questionnaire survey method was used in this research. Participants were recruited from various Chinese ODCs, generating data for a main study and 2 robustness checks. Hierarchical multiple regression analyses and bootstrapping analyses were adopted as the primary methods to test the hypotheses.

RESULTS

We received 1515 valid responses in total, contributing to 5 different datasets: model IGC (n=353, 23.3%), model UGC (n=358, 23.63%), model IGC+UGC (n=270, 17.82%), model IGC-B (n=266, 17.56%), and model UGC-B (n=268, 17.69%). Models IGC and UGC were used for the main study. Model IGC+UGC was used for robustness check A. Models IGC-B and UGC-B were used for robustness check B. Useful IGC and positive UGC were proven to have positive impact on the attitudes of patients with depression toward medication adherence through the mediations of perceived social support and perceived value of antidepressants. The findings corroborated the role of hopelessness in weakening or even negating the positive effects of ODC content on the attitudes of patients with depression toward medication adherence.

CONCLUSIONS

This study provides the first empirical evidence demonstrating the relationship between ODC content and attitudes toward medication adherence, through which we offer a novel solution to the problem of poor medication adherence among patients with depression in China. Our findings also provide suggestions about how to optimize this new approach-health care practitioners should generate online content that precisely matches the informational needs of patients with depression, and ODC service providers should endeavor to regulate the community atmosphere. Nonetheless, we warn that ODC interventions cannot be used as the only approach to addressing the problem of poor medication taking among patients with severe depressive symptoms.

Barriers and opportunities for the treatment of mild-to-moderate depression with a watchful waiting approach

OBJECTIVE

The aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs).

METHODS

Qualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented.

RESULTS

The results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients' preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services.

CONCLUSION

Based on FPs' perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients' preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals.

PRACTICE IMPLICATIONS

Resources for education, structural support in PC and modified back up from mental healthcare services are needed.

Use of Mental Health Services for Patients Diagnosed with Major Depressive Disorders in Primary Care

Major depressive disorder (MDD) is one of the most disabling diseases worldwide, generating high use of health services. Previous studies have shown that Mental Health Services (MHS) use is associated with patient and Family Physician (FP) factors. The aim of this study was to investigate MHS use in a naturalistic sample of MDD outpatients and the factors influencing use of services in specialized psychiatric care, to know the natural mental healthcare pathway. Non-randomized clinical trial including newly depressed Primary Care (PC) patients (n = 263) with a 12-month follow-up (from 2013 to 2015). Patient sociodemographic variables were assessed along with clinical variables (mental disorder diagnosis, severity of depression or anxiety, quality of life, disability, beliefs about illness and medication). FP (n = 53) variables were also evaluated. A multilevel logistic regression analysis was performed to assess factors associated with public or private MHS use. Subjects were clustered by FP. Having previously used MHS was associated with the use of MHS. The use of public MHS was associated with worse perception of quality of life. No other sociodemographic, clinical, nor FP variables were associated with the use of MHS. Patient self-perception is a factor that influences the use of services, in addition to having used them before. This is in line with Value-Based Healthcare, which propose to put the focus on the patient, who is the one who must define which health outcomes are relevant to him.