From outpatient secondary mental health services to primary care: patients' perspectives on depression treatment and relapse prevention - a qualitative study.

Abstract

Purpose: Patients with severe depression often transition from outpatient secondary mental health services to primary care before full recovery, risking relapse and rehospitalisation. However, evidence to ensure a safe transition is limited. This study aimed to explore how patients with severe depression experienced their intensive outpatient treatment, how they perceived their upcoming transition to primary care, and which elements they considered essential for relapse prevention.

Materials and methods: Twelve patients with severe depression from an intensive outpatient clinic were interviewed. Data were analysed using interpretative phenomenological analysis.

Results: Patients valued safety and psychiatric expertise during their outpatient treatment. Individually delivered sessions were preferred over group-based formats. As discharge approached, many still felt vulnerable and worried about relapse, particularly due to the loss of contact with psychiatric professionals and pressure from the job centre to return to work. Patients suggested relapse prevention elements, including tailored outpatient treatment addressing individual needs before discharge, flexible return-to-work approaches and the possibility of access to psychiatric professionals after discharge with continuity of care from a familiar psychiatric professional, as well as digital self-monitoring tools with clinical feedback.

Conclusions: The results highlight the need for outpatient services tailored to individual, patient-centred needs, ensuring continuity of care from secondary to primary care via familiar psychiatric professionals, and providing flexible return-to-work support. A well-coordinated transition, developed collaboratively with the patient and cross-sectoral professionals, is essential. Post-discharge, continued contact with known psychiatric professionals, supported by self-monitoring tools with clinical feedback, may prevent relapse of severe depression.