Developing inclusive approaches to multidimensional mental health assessment in UK primary care: A qualitative study and community outreach approach

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

3B.3

Presenter:

Adam Geraghty

Co-authors:

Adam W A Geraghty, Sian Williamson, Carolyn A. Chew-Graham, Miriam Santer, Michael Moore, Tony Kendrick, Berend Terluin, Paul Little, Beth Stuart, Sonia Newman, Shanaya Rathod, Manoj Mistry, Al Richards, Debs Smith, Harm van Marwijk.

Author institutions:

University of Southampton, Brighton and Sussex Medical School, Keele University, Amsterdam University Medical Centre

Problem

The four-dimensional symptom questionnaire (4DSQ) is a measure recommended in Dutch national guidelines. The 4DSQ uniquely provides a profile of a patients’ symptoms on dimensions of distress, depression, anxiety and related physical symptoms (splitting stress from disorder). The 4DSQ is not widely used the UK. It may facilitate diagnostic conversations, support targeted treatment, and potentially reduce unnecessary over-treatment with antidepressants. We aimed to explore peoples’ experiences of completing the 4DSQ and their perceptions of their score profile across the four symptoms. We also aimed explore a diverse groups’ experiences and perceptions of distinctions between distress and disorder through community outreach work

Approach

A qualitative study was used to explored peoples’ experience of completing the 4DSQ. Participants were recruited from community routes (e.g. through a local Sure Start centre) and via GP practices. Participants completed the 4DSQ then took part in in-depth telephone interviews about their mental health experience, completing the 4DSQ, and their perception of their scores. Interviews were transcribed verbatim, and thematic analysis is on-going. Community outreach/public contributor events were held at a local Sure Start centre, combined with meetings organised through the Beth Johnson Foundation (BJF) and meetings with individuals from diverse communities.

Findings

Twenty-four interviews were conducted. Early analysis shows the current complexity in the understanding and use of labels such as stress, depression, and anxiety in a primary care context. Participants were generally positive regarding the 4DSQ: describing that that their emotional experiences were validated, that the 4DSQ may be helpful in opening conversations, and valued the potential to score differently on each dimension (e.g. distress and depression). Four community outreach events were held at a local Sure Start, two BJF meetings, five individual meetings. There was wide agreement that distinguishing distress from disorder would be helpful, along with proposals for support for distress without disorder. The Sure Start group developed a model for care for those experiencing heightened distress that will be used in on-going work.

Consequences

This research is ongoing, and full details will be presented at the conference. However, the 4DSQ appears to have potential for use in UK general practice. Community outreach approaches with diverse groups greatly aided our understanding of issues affecting the development of a future clinical process for the 4DSQ, as well as how to ensure we use inclusive research methods going forward.

Submitted by:

Adam Geraghty

Funding acknowledgement:

This study/project is funded by the NIHR Programme Development Grants (NIHR203688). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.