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Depression means different things: A qualitative study of psychiatrists' conceptualization of depression in the palliative care setting

Published online by Cambridge University Press:  21 October 2014

Felicity Ng ,
Gregory B. Crawford  and
Anna Chur-Hansen
Felicity Ng*
Affiliation:
Consultation–Liaison Psychiatry, Lyell McEwin Health Service, Northern Adelaide Local Health Network, Elizabeth Vale, South Australia, Australia Discipline of Psychiatry, School of Medicine, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia
Gregory B. Crawford
Affiliation:
Discipline of Medicine, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia Central Adelaide Palliative Care Service, Central Adelaide Local Health Network, Woodville, South Australia, Australia
Anna Chur-Hansen
Affiliation:
School of Psychology, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia
*
Address correspondence and reprint requests to: Felicity Ng, Mental Health Unit, Lyell McEwin Health Service, Oldham Road, Elizabeth Vale, South Australia 5112, Australia. E-mail: [email protected]
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Abstract

Objective:

Medical practitioners conceptualize depression in different ways, which adds to the challenges of its diagnosis and treatment, as well as research in the palliative care setting. Psychiatric assessment is often considered the “gold standard” for diagnosis, therefore how psychiatrists conceptualize depression in this setting is pertinent. Our study aimed to investigate this issue.

Method:

Psychiatrists working in palliative care in Australia were individually interviewed using a semistructured approach. Nine participants were interviewed to reach data saturation. Interview transcripts were analyzed for themes.

Results:

Three overarching themes were identified: (1) depression means different things; (2) depression is conceptualized using different models; and (3) depression is the same concept within and outside of the palliative care setting. Participants explicitly articulated the heterogeneous nature of depression and described a different breadths of concepts, ranging from a narrow construct of a depressive illness to a broader one that encompassed depressive symptoms and emotions. However, depressive illness was a consistent concept, and participants considered this in terms of phenotypic subtypes. Participants used three models (spectral, dichotomous, and mixed) to relate various depressive presentations.

Significance of Results:

Psychiatrists did not subscribe to a unitary model of depression but understood it as a heterogeneous concept comprised of depressive illness and other less clearly defined depressive presentations. Given the influence of psychiatric opinion in the area of depression, these findings may serve as a platform for further discussions to refine the concepts of depression in the palliative care setting, which in turn may improve diagnostic and treatment outcomes.

Keywords

DepressionPalliative careTerminal careConcept formationPsychiatry
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1223 - 1230
Copyright
Copyright © Cambridge University Press 2014 

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