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 GPs in primary care.

Aim: To understand the extent to which relapse risk and prevention are discussed and managed in general practice.

Design and setting: A qualitative study undertaken in general practice in the UK.

Method: Participants were recruited through 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 22 GPs were interviewed. The following three themes are presented in this paper: perceived determinants of depression course (participants viewed environmental, social, and personal factors as being most important); relapse risk and prevention (relapse was considered important but not consistently or routinely discussed in general practice consultations); and relationships and communication (participants discussed the key role of the GP-patient relationship). Conceptually, relapse was perceived as having limited meaning and usefulness in primary care, owing 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 enhance longer-term care and support for people with depression. Going forwards, acute depression management could be optimised to include discussions of relapse risk and prevention. Brief, scalable relapse prevention interventions are needed for use in primary care.