title: Following up patients with depression after hospital discharge: a mixed methods approach.
abstract: BACKGROUND
  A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge.
  
  
  METHODS
  The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90 and recording the number of readmissions) and humanistic (using the Quality of Life Enjoyment and Satisfaction Questionnaire) outcomes of patients via telephone contacts up to one year following discharge. The qualitative analysis was based on the researcher diary, consisting of reports on the telephone outcome assessment of patients with major depression (n = 99). All reports were analyzed using the thematic framework approach.
  
  
  RESULTS
  The change in the participants' health status was as diverse as it was at hospital discharge. Participants reported on remissions; changes in mood; relapses; and re-admissions (one third of patients). Quantitative data on group level showed low anxiety, depression and somatic scores over time. Three groups of contributing factors were identified: process, individual and environmental factors. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. Individual factors were symptom control, medication and personality. Environmental factors were material and social environment. Each of them could ameliorate, deteriorate or be neutral to the patient's health state. A mix of factors was observed in individual patients.
  
  
  CONCLUSIONS
  After hospital discharge, participants with a major depressive episode evolved in many different ways. Process, individual and environmental factors may influence the participant's health status following hospital discharge. Each of the factors could be positive, neutral or negative for the patient.
authors.affiliation: Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, ON2 Herestraat 49 P.O.Box 521, 3000 Leuven, Belgium.
authors.forename: Franciska A
authors.initials: FA
authors.lastname: Desplenter
authors.affiliation: Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, ON2 Herestraat 49 P.O.Box 521, 3000 Leuven, Belgium.
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Laekeman
authors.affiliation: Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, ON2 Herestraat 49 P.O.Box 521, 3000 Leuven, Belgium.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simoens
references.citation: J Affect Disord. 2008 Oct;110(3):215-21
references.pmid: 18321592
references.citation: Int J Geriatr Psychiatry. 2002 Mar;17(3):238-46
references.pmid: 11921152
references.citation: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references.pmid: 6880820
references.citation: J Clin Psychiatry. 2004;65 Suppl 4:53-9
references.pmid: 15046542
references.citation: J Abnorm Psychol. 1989 Aug;98(3):229-35
references.pmid: 2768657
references.citation: Psychopharmacol Bull. 1993;29(2):321-6
references.pmid: 8290681
references.citation: BMC Health Serv Res. 2008 Jul 21;8:152
references.pmid: 18644110
references.citation: Drug Alcohol Depend. 2001 Jan 1;61(2):137-43
references.pmid: 11137278
references.citation: Int J Clin Pharm. 2011 Feb;33(1):101-10
references.pmid: 21365402
references.citation: Complement Ther Med. 2005 Dec;13(4):297-302
references.pmid: 16338201
references.citation: Depression. 1996;4(2):63-7
references.pmid: 9160642
references.citation: Curr Psychiatry Rep. 2004 Jun;6(3):193-201
references.pmid: 15142472
references.citation: J Consult Clin Psychol. 2008 Feb;76(1):92-103
references.pmid: 18229987
references.citation: J Affect Disord. 1998 Sep;50(2-3):97-108
references.pmid: 9858069
references.citation: J Nurs Scholarsh. 2005;37(4):348-53
references.pmid: 16396408
references.citation: Harv Rev Psychiatry. 2008;16(4):225-34
references.pmid: 18661365
references.citation: Hosp Community Psychiatry. 1992 Oct;43(10):1000-4
references.pmid: 1398562
references.citation: JAMA. 2007 Feb 28;297(8):831-41
references.pmid: 17327525
references.citation: Psychopharmacol Bull. 1973 Jan;9(1):13-28
references.pmid: 4682398
references.citation: Am J Health Syst Pharm. 2005 Aug 15;62(16):1714-20
references.pmid: 16145778
references.citation: J Psychiatr Res. 2009 Jan;43(3):215-29
references.pmid: 18586274
references.citation: Pharm World Sci. 2006 Dec;28(6):329-41
references.pmid: 17216295
references.citation: Qual Health Res. 2000 Jul;10(4):555-67
references.pmid: 11010078