‘Justifiable depression’: How primary care professionals and patients view late-life depression? A qualitative study
Abstract
BACKGROUND: Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated. AIM: To explore the ways that primary care professionals and patients view the causes and management of late-life depression. DESIGN: A qualitative study using semistructured interviews. SETTING: One Primary Care Trust in North West England. PARTICIPANTS: Fifteen primary care practitioners comprising nine GPs, three practice nurses, two district nurses and one community nurse; twenty patients who were over the age of 60 and who were participating in a feasibility study of a new model of care for late-life depression [PRIDE Trial: PRimary care Intervention for Depression in the Elderly (a feasibility study in Central Manchester funded by the Department of Health)]. RESULTS: Primary care practitioners conceptualized late-life depression as a problem of their everyday work, rather than as an objective diagnostic category. They described depression as part of a spectrum including loneliness, lack of social network, reduction in function and viewed depression as 'understandable' and 'justifiable'. This view was shared by patients. Therapeutic nihilism, the feeling that nothing could be done for this group of patients, was a feature of all primary care professionals' interviews. Patients' views were characterized by passivity and limited expectations of treatment. Depression was not viewed as a legitimate illness to be taken to the GP. Primary care professionals recognized that managing late-life depression did fall within their remit, but identified limitations in their own skills and capabilities in this area, as well as a lack of other resources to which they could refer patients. CONCLUSION: This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.
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Older people with long-term conditions may normalize their depression, or view their long-term physical condition(s) as a 'justifiable' cause of low mood.
“Older people with LTCs may normalize their depression, or view their long-term physical condition(s) as a ‘justifiable’ cause of low mood [22–24].”
From Can support workers from AgeUK deliver an intervention to support older people with anxiety and depression? A qualitative evaluation (2019) · cites this paper as [24]
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- Authors
- Burroughs, H.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- Burroughs, H.
- ORCID
- Burroughs, H.
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-02-03
- Volume
- 23
- Issue
- 3
- Pages
- 369-377
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2167068556
- Cited by
- 220
- References
- 32
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 10 · 2023: 6 · 2022: 8 · 2021: 12 · 2020: 11 · 2019: 15 · 2018: 15 · 2017: 11 · 2016: 13 · 2015: 11 · 2014: 16 · 2013: 8 · 2012: 19
- FWCI
- 14.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- geriatric depression, primary care providers, elderly patients, therapeutic nihilism, underdiagnosis, undertreatment, social determinants of mental health, loneliness, social networks, GP perceptions, patient help-seeking, biomedical model
- MeSH terms
- Anecdotes as Topic, Attitude of Health Personnel, Depressive Disorder, Female, Geriatric Psychiatry, Humans, Male, Physicians, Family, Primary Health Care, Qualitative Research
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