title: How patients with depressive symptoms view their condition: a qualitative study.
abstract: BACKGROUND
  Depressive symptoms are common in primary care, yet considerable professional controversy exists about appropriate management including the effectiveness of treatments. In addition, avoiding prescribing antidepressants at least initially is recommended. Views of patients themselves should therefore be particularly important in agreeing management strategies.
  
  
  OBJECTIVE
  To examine lay beliefs about depressive symptoms in primary care.
  
  
  METHODS
  A total of 23 semi-structured interviews were conducted with patients scoring positively for depression on the Hospital Anxiety and Depression Score in a primary care setting.
  
  
  RESULTS
  Differentiating 'depression' from understandable reactions to adversity was difficult for patients. The wide range of consequences discussed included adverse effects on others, difficulties coping with feeling out of control and loss of self-identity. Negative images of depression, such as depression being a 20th century phenomenon, were pervasive. Views about medication varied. Various management strategies described included strategies of detachment, engagement in activities and 'blotting out' symptoms.
  
  
  CONCLUSIONS
  Patients' views about depressive symptoms are significantly different from conventional medical views. A 'disease management approach' fits uncomfortably with patients' experiences. Acknowledging feelings of loss of control and loss of self-identity in consultations may be useful. The wide employment of techniques patients use to control their disorders, such as support from others, engagement in activities and working at relationships, may be useful to encourage in consultations as alternatives to the use of antidepressant medication.
authors.affiliation: Centre for Integrated Health Care Research, University of Durham, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, TS17 6BH, UK. charles.cornford@durham.ac.uk
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cornford
authors.forename: Angela
authors.initials: A
authors.lastname: Hill
authors.forename: Joe
authors.initials: J
authors.lastname: Reilly
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003863:Depression / Q000503:physiopathology* / Q000523:psychology; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011320:Primary Health Care; D011795:Surveys and Questionnaires