Depression and chronic physical disease: a Q-methodology study of patients with co-morbidity

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The Problem:Depression screening in chronic disease has been proposed to increase detection and was recently implemented via a national primary care financial incentive scheme within the UK . We aimed to identify socially shared attitudes of co-morbid depression and chronic disease and the key areas they overlap or differ, as part of planning future strategy in this area.

The approach

All patients with diabetes and/or coronary heart disease with a recent diagnosis of depression were invited from three UK general practices. Q methodology was used and participants ranked statements of beliefs about depression. By-person factor analysis was used to identify patterns in the ranking of statements. A post-sort interview aided analysis.


Thirty-two patients took part, of which 42% had current depression symptoms. Seven attitudes towards co-morbid depression were identified: (1) Overwhelmed resources, (2) Something within me, (negative 2) I don't understand, (3) A shameful weakness, (4) Always negative, (5) Recovery orientated, (negative 5) Childhood trauma. The attitudes differed in their beliefs on the cause of depression, the relationship with chronic disease, the experience of shame and whether medical interventions would help them recover. All groups agreed that seeing a health professional was only somewhat important.


Q-methodology can help to identify where there is consensus and where there are likely to be barriers to either clinical practice or policy intervention. This study has shown that there are groups of patients who do not see a relationship between their co-morbidities and so may not understand the intention behind depression screening within chronic disease reviews such as the policy intervention introduced but subsequently discontinued in the UK. To improve identification and management of depression in primary care we need to tailor strategies to these clusters in order to provide individualized care.


  • Sarah Alderson
  • Robbie Foy
  • Allan House