8.7.1 Symptoms of ulceration or symptoms of depression? (247)

June Jones, Research Nurse Tissue Viability, Health and Community Care Research Unit, Bolton Primary Care Trust, Bolton, United Kingdom Co authors: Jude Robinson & Wally Barr jonj@btinternet.com

Abstract:

Aim:

This paper reports findings from a two phase study exploring the prevalence and experience of depression in patients with chronic venous ulceration, dealing specifically with the management of ulceration from the patient’s perspective.

Background:

Studies consistently show an association between physical illness such as arthritis and diabetes with depression (Noel et al 2004) However, depression is frequently unrecognised, hence under-diagnosed and therefore under-treated. Patients with chronic venous ulceration are never routinely assessed for depression despite displaying many of the symptoms such as insomnia, fatigue, anhedonia etc. Without treatment, depression has the tendency to assume a chronic course, be recurrent and over time be associated with increasing disability (Andrews 2001).

Method:

Phase I, The Hospital Anxiety and Depression Scale (HADS) was used to screen 190 patients with chronic venous ulceration across 9 NHS Trusts in the North West of England for the presence of anxiety and depression.

Phase II Purposively sampled 20 people identified during Phase I and used a phenomenological hermeneutic approach to explore the experiences of depression

Results:

The Phase I sample of 101 males and 89 females had a median age of 69 years. For both anxiety and depression subscales of the HADS, a cut-off of 9 was used as indicative of caseness: 52 (27%) scored as depressed, whilst 50 (25%) individuals scored as anxious.

The Phase II stories describe people left in a world they didn’t want to be in, a world of pain and suffering expressing overwhelming emotions of frustration, anger, endurance, sadness, sorrow, hopelessness and gloom

Discussion:

This paper discusses the misattribution of symptoms by health care professionals, who attribute aspects such as fatigue, insomnia, a sense of loss and hopelessness to venous disease rather than to the depression of which they are classic symptoms.

Recommended reading list:

  • Noel PH, Williams JW Jnr, Unutzer J et al (2004) Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being. Ann Fam Med 2: 555-62
  • Andrews G (2001) Should depression be managed as a chronic disease? BMJ 322: 419-21

Source of Funding: UK - Health Service (National)

Amount in Funding: 50,001 - 100,000

Biography:

I work part time as a research nurse in tissue viability and also as a wound care advisor. My main passion is leg ulcers and I was awarded a DoH funded fellowship in 2001 to study part time for a PhD at the University of Liverpool, completing in 2007.