The role of primary care in depression relapse: a qualitative study.

Abstract

Background Relapse contributes to the clinical and societal burden associated with depression. It is not well understood how relapse risk and prevention are managed and discussed between patients and general practitioners in primary care. Aim To understand the extent to which relapse risk and prevention are discussed and managed in general practice. Design and Setting Qualitative study in general practice. Method Participants were recruited through UK general practices. Data were generated using semi-structured interviews and analysed using thematic analysis. Patient and public involvement informed all aspects of the study. Results Twenty-three people with lived experience of depression and twenty-two GPs were interviewed. Three themes are presented in this paper: perceived determinants of depression course (participants viewed environmental, social and personal factors as being most significant); relapse risk and prevention (relapse was considered important but not consistently or routinely discussed in general practice consultations); and the key role of the GP-patient relationship and communication. Conceptually, relapse was perceived as having limited meaning and usefulness in primary care, due to the implication of an episodic, discrete course not recognised by many patients and an over-reliance on biomedical diagnosis. Longer-term follow-up and monitoring of depression could be improved in primary care. Conclusion We provide an evidence-informed framework to improve practice systems and GP consultations to improve longer-term care and support for people with depression. Going forwards, brief scalable relapse prevention interventions are needed to improve the ongoing care of people with depression in primary care; implementing these would require additional primary care resources.