title: Matching services to patients' beliefs about depression in Dublin, Ireland.
abstract: OBJECTIVE
  This study explored tensions between biomedical and psychosocial illness models and between the public health goal of stigma reduction and patients' perceptions of helplessness. Patients' etiological beliefs and use of language are considered as possible pathways to improved care.
  
  
  METHODS
  Qualitative and quantitative data were obtained from 18 adults attending a mood disorders support group in Dublin, Ireland.
  
  
  RESULTS
  Respondents reported feelings of helplessness concerning the occurrence of depressive episodes. When describing episodes of wellness and depression, respondents used a "light switch" metaphor to indicate this lack of control. For several respondents, acceptance of biomedical causality was linked to helplessness. In contrast, spiritual beliefs offered hope.
  
  
  CONCLUSIONS
  Alleviating patients' sense of responsibility may reduce their guilt, but patients' perceptions of illness uncontrollability may diminish their sense of agency, reinforce depressive attributional styles, and undermine overall treatment outcomes. Communication and the patients' involvement in decisions are vital to treatment.
authors.affiliation: Institute of Geriatric Psychiatry, Weill Medical College of Cornell University, 21 Bloomingdale Rd., White Plains, NY 10605, USA. joc2038@med.cornell.edu
authors.forename: Joanne
authors.initials: J
authors.lastname: Cunningham
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Sirey
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D003863:Depression; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D007802:Language; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011795:Surveys and Questionnaires