A qualitative examination of the experience of 'depression' in hospitalized medically ill patients.
BACKGROUND
Research into depression in the medically ill has progressed without sufficient attention being given to the validity, in this group, of the taxonomic categories. We aimed to describe, using qualitative interviews, the experience of 'being depressed', separating experiences that are unique to depression from experiences that are common to being ill and in hospital.


METHODS
Forty-nine patients hospitalized for medical illness underwent a 30-min interview in which they were asked to 'Describe how you have been unwell and, in particular, how that has made you feel.' From the transcripts, a 'folk' taxonomy was constructed using a phenomenological framework involving four steps: frame elicitation to identify the important themes, componential analysis to systematically cluster the attributes into domains, a comparison of the experiences of patients screening depressed and not-depressed, and a theoretical analysis comparing the resulting taxonomy with currently used theoretical constructs.


RESULTS
Experiences common to all patients were being in hospital, being ill or in pain, adjusting to not being able to do things, and having time to think. In addition, all participants described being depressed, down or sad. Patients who were identified by screening as being depressed described unique experiences of depression, which included 'having to think about things' (a forceful intrusive thinking), 'not being able to sleep', 'having to rely on others', 'being a burden' to others (with associated shame and guilt), feelings of 'not getting better' and 'feeling like giving up'. Theoretical analysis suggested that this experience of depression fitted well with the concept of demoralization described by Jerome Frank.


CONCLUSIONS
Demoralization, which involves feelings of being unable to cope, helplessness, hopelessness and diminished personal esteem, characterizes much of the depression seen in hospitalized medically ill patients.
Clarke
David M
DM
Department of Psychological Medicine, Monash University, Melbourne, Australia. david.clarke@med.monash.edu.au
Cook
Kay E
KE
Coleman
K John
KJ
Smith
Graeme C
GC
D000208:Acute Disease / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D017281:Cost of Illness; D003863:Depression / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006167:Guilt; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D012917:Social Adjustment