title: Clinical problems in the long-term care of patients with chronic depression.
abstract: OBJECTIVE
  This paper is a report of a study to explore problems encountered by mental health professionals in the long-term care of patients with chronic depression.
  
  
  BACKGROUND
  Patients who do not profit from psychopharmacological or psychotherapeutic treatment often need long-term care. Although they experience severe symptoms and loss of functioning, little is known about these people and the care they receive.
  
  
  METHODS
  Experts in chronic depression (n = 8) participated in a four-phase Delphi study in 2006-2007. Problems were elicited through a focus group interview (first round) which was analysed using thematic analysis. The resulting problem list was validated (second round) and scored twice on a 7-point Likert scale (third and fourth rounds) by the participants. Urgency and changeability scores of 35 problems were obtained and a hierarchy of problems was set. In addition, qualitative data from the focus group interview were used to frame the results in the context of long-term care for patients with chronic depression.
  
  
  RESULTS
  Problems were subdivided into five areas. Relapses by the patient, a pessimistic attitude by the professional and demoralization in both were major problems. Also noted were the negative societal connotations of chronic depression and the lack of a coherent view on treatment within mental health care.
  
  
  CONCLUSIONS
  Chronicity of depression may be denied by both patients and professionals, resulting in an overly strong focus on cure and a limited quality of care. The results may be used as a starting point for construction of a best-practice programme to improve long-term care.
authors.affiliation: Department of Outpatient Community Care, Altrecht Mental Health Care, Zeist, The Netherlands. b.koekkoek@altrecht.nl
authors.forename: Bauke
authors.initials: B
authors.lastname: Koekkoek
authors.forename: Berno
authors.initials: B
authors.lastname: van Meijel
authors.forename: Aart
authors.initials: A
authors.lastname: Schene
authors.forename: Giel
authors.initials: G
authors.lastname: Hutschemaekers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D003156:Community Mental Health Services / Q000592:standards*; D003695:Delivery of Health Care; D003697:Delphi Technique; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D011795:Surveys and Questionnaires