General practitioners' and practice nurses' views and experience of managing depression in coronary heart disease: a qualitative interview study.
BACKGROUND
Depression is common in coronary heart disease (CHD). Affected patients have an increased incidence of coronary symptoms and death. Little is known about how best to manage primary care patients with both CHD and depression. This study is part of the UPBEAT-UK programme of research and was designed to understand general practitioners' (GPs) and practice nurses' (PNs) views and experience of managing depression in CHD.


METHODS
Individual in-depth interviews with 10 GPs and 12 PNs in South East London. Data were analysed using constant comparison.


RESULTS
GPs and PNs had similar views. Distress following diagnosis or a cardiac event was considered to resolve spontaneously; if it endured or became severe it was treated as depression. GPs and PNs felt that psychosocial problems contributed to depression in patients with CHD. However, uncertainty was expressed as to their perceived role and responsibility in addressing these. In this respect, depression in patients with CHD was considered similar to depression in other patients and no coherent management approach specific for depression in CHD was identified. An individualised approach was favoured, but clinicians were unsure how to achieve this in the face of conflicting patient preferences and the treatment options they considered available.


CONCLUSIONS
GPs and PNs view depression in CHD similarly to depression uncomplicated by physical illness. However, uncertainty exists as to how best to manage depression associated psychosocial issues. Personalised interventions are needed which account for individual need and which enable and encourage clinicians and patients to make use of existing resources to address the psychosocial factors which contribute to depression.
Section of Primary Care Mental Health, Health Services and Population Research Department, PO Box 28, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK. elizabeth.barley@iop.kcl.ac.uk
Elizabeth A
EA
Barley
Paul
P
Walters
André
A
Tylee
Joanna
J
Murray
D000328:Adult; D001291:Attitude of Health Personnel; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D010595:Pharmacists / Q000523:psychology / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D011364:Professional Practice / Q000458:organization & administration; D036301:Qualitative Research