General practitioners' and practice nurses' views and experience of managing depression in coronary heart disease: a qualitative interview study

Individual in-depth interviews with 10 GPs and 12 PNs in South East London. Data were analysed using constant comparison.GPs and PNs had similar views. Distress following diagnosis or a cardiac event was considered to resolve spontaneously; if it endured or became severe it was treated as depression. GPs and PNs felt that psychosocial problems contributed to depression in patients with CHD. However, uncertainty was expressed as to their perceived role and responsibility in addressing these. In this respect, depression in patients with CHD was considered similar to depression in other patients and no coherent management approach specific for depression in CHD was identified. An individualised approach was favoured, but clinicians were unsure how to achieve this in the face of conflicting patient preferences and the treatment options they considered available.GPs and PNs view depression in CHD similarly to depression uncomplicated by physical illness. However, uncertainty exists as to how best to manage depression associated psychosocial issues. Personalised interventions are needed which account for individual need and which enable and encourage clinicians and patients to make use of existing resources to address the psychosocial factors which contribute to depression.Coronary Heart Disease (CHD) can cause distressing symptoms and functional limitation. The prevalence of depression in CHD patients has been estimated at 20%[1]. Depression increases the incidence of coronary symptoms and death in CHD patients independent of other factors [1]. It may also exacerbate the perceived severity of symptoms and increase service use [2].Concurrent physical illness reduces the recognition of depression by GPs [3]; accordingly, in the UK, GPs are now remunerated for screening CHD patients for depression [4]. Antidepressants and CBT have been found to improve mood in CHD, although physical health outcomes have not improved [5,6]. A recent trial of collaborative care, an enhanced d