新加坡全科医生对晚年抑郁症的看法定性研究--第一部分:病人的表现和行为

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-08-12 DOI:10.1016/j.lanwpc.2024.101170
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引用次数: 0

摘要

背景晚年抑郁症的检测和管理主要依赖于初级保健。然而,在新加坡,老年人不太可能向初级保健提供者寻求心理健康帮助。这项定性描述性研究探讨了新加坡初级医疗机构中的全科医生(GPs)是如何看待晚年抑郁症的。方法在网上进行的半结构化小组和个人讨论中,28 名在新加坡执业的私人全科医生被问及他们对晚年抑郁症的临床经验。参与者的年龄、性别和种族(华裔、马来裔、印度裔)均有针对性。研究结果对全科医生而言,老年患者的抑郁症通常表现为躯体症状或细微的行为变化,只有通过随访或旁证病史才能发现。据全科医生报告,老年患者将抑郁症状归因于正常的衰老或不予提及,尤其是在鼓励坚忍不拔的亚洲文化中。全科医生认为,晚年抑郁症是对与衰老有关的压力的反应,男性、低收入或住在养老院的病人尤其容易患上隐匿性严重抑郁症。全科医生注意到在家庭参与护理方面存在着种族差异,他们认为家庭参与护理很有帮助,但有时也会给患者带来压力。害怕负担过重或失去自主权/社会角色可能会促使患者拒绝接受诊断和治疗。全科医生认为,良好的医患关系是护理过程中每一步的促进因素,并指出,护理一致的患者预后更佳。解释新加坡老年人的抑郁症可能具有隐蔽性,能否取得良好的疗效取决于全科医生能否捕捉到细微的变化、全面评估患者以及与患者和家属建立良好关系:本研究由全科医学科研究能力建设预算项目 "技术与仁爱:通过数据分析和患者在初级医疗中的声音改善患者的治疗效果"[NUHSRO/2022/049/NUSMed/DFM]资助。
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A qualitative study on general practitioners’ perspectives on late-life depression in Singapore—part I: patient presentations and behaviours

Background

Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting.

Methods

Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis.

Findings

To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families’ involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients.

Interpretation

Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs’ ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families.

Funding

This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project “Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients’ Voice in Primary Care” [NUHSRO/2022/049/NUSMed/DFM].

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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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