Depressed patients need the right kind of support

By Sally Robertson, B.Sc.Jul 10 2012

Clinicians should be aware of the potential detrimental effects the behavior of family and friends can have on depressed individuals, report US researchers.

Negatively perceived comments made by friends and relatives can not only cause significant emotional pain to people who are depressed, but can also lead to an unwillingness to discuss depression with healthcare professionals, potentially preventing follow through with treatment, they say.

Using audio recordings from 15 focus group discussions held for people with first-hand experience of depression (n=116), the researchers identified four broad themes relating to negatively interpreted messages among the participants, namely, those that made them feel labeled, judged, lectured, or rejected.

As reported in BMC Family Practice, participants recalled feeling labeled because of their depressive symptoms if they were, for example, described as "always so serious" or if they were called "sissy" for wanting to discuss their feelings.

Patients also recalled feeling judged with regard to their depression when friends or relatives asked questions such as: "But you've got so much to be glad for?" or "You have this, you have that… why are you so miserable all the time?"

Another example of judgment the participants reported was related to people placing depressive symptoms in the context of presumed inheritance or genetic predisposition, with the patients remembering comments such as: "You inherited from your dad this chemical imbalance."

In addition, the researchers found that relatives and friends were reported to move beyond labeling and judging, to "lecturing" their depressed family members, by providing advice that was perceived as repeated, one-sided, and unhelpful such as "get over it," "snap out of it," or "you'll be fine."

Finally, participants reported members of their social network disengaging, rejecting, or shunning them when they attempted to discuss their depression or the depression treatment options.

"Importantly, such rejection may have inhibited further depression themed discussion at the time and in the future," say the researchers who report that several of the participants' relatives said that they did not "believe" in psychologists or "agree" with counsellors.

"By serving as one of many potential normative counter-weights, primary care clinicians can help patients interpret and respond to their often unforgiving social environments," say Erik Fernandez y Garcia (University of California, Sacramento) and colleagues.

"Clinician's knowledge of patients' sources of positive and negative social support can help enhance positive social influences and mitigate those that are unhelpful," they conclude.

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