The first consultation for low mood in general practice: what do patients find helpful?

Background: Recent evidence suggests that the first consultation with a general practitioner (GP) for symptoms of depression may be more than just a vehicle for assessment and management planning (as current guidelines imply).

Objectives: To identify what patients find helpful, or otherwise, in their first consultation for low mood with a GP.

Methods: A cross-sectional questionnaire and interview study of patients with low mood who had recently consulted their GP, in the North of England.

Co-creation and collaboration: A promising approach towards successful implementation. Experience from an integrated communication and mental health skills training programme for Japanese General Practice.

Introduction: This paper describes the co-creation and delivery of an integrated training programme in communication and depression assessment & management for Japanese GPs.

Methods: Experts in communication and depression from EACH and WONCA developed a framework and filled it with content. Through iterative discussions with the Japanese participants and experts during delivery, the training was further adjusted to match local needs.

Involving migrants in the adaptation of primary care services in a 'newly' diverse urban area in Ireland: The tension between agency and structure.

In line with World Health Organization policy (WHO, 2016; 2019), primary care services need to be adapted to effectively meet the needs of diverse patient populations. Drawing from a European participatory implementation study, we present an Irish case study. In a hybrid participatory space, migrants, general practice staff and service planners (n = 11) engaged in a project to implement the use of trained interpreters in primary care over 17 months.

Comparing public perceptions of substance addictions and behavioural addictions.

Introduction: Identifying addictions in peers is vital for early referral and improving outcomes. Substance addictions such as alcoholism and cocaine addiction have been recognised for a long time whereas behavioural addictions such as gambling and especially gaming are relatively new addictions. This study aims to evaluate public perceptions of substance addictions compared to behavioural addictions.

The APEC Digital Hub-WONCA Collaborative Framework on Integration of Mental Health into Primary Care in the Asia Pacific.

Mental ill health affects individual well-being and national economic prosperity and makes up a substantial portion of the burden of disease globally, especially in the Asia-Pacific region. Integrating mental health into primary care is widely considered a key strategy to improve access to mental health care. Integration, however, is a complex process that needs to be addressed at multiple levels.

Effectiveness of mental health community training on depression and anxiety to the health care profession working in rural centers of eastern Nepal.

Background: Depression and anxiety is the leading cause of disease burden in low- and middle-income countries. It is associated with a worse clinical course over the lifespan. This study aims the post-effect on the approach of managing depression and anxiety after the training on diagnosis and management of depression and anxiety.

Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory, evidence and person-based approach.

Objectives: We aimed to develop a digital intervention to support antidepressant discontinuation in UK primary care that is scalable, accessible, safe and feasible. In this paper, we describe the development using a theory, evidence and person-based approach.

Design: Intervention development using a theory, evidence and person-based approach.

Material practices for meaningful engagement: An analysis of participatory learning and action research techniques for data generation and analysis in a health research partnership.

Background: The material practices which researchers use in research partnerships may enable or constrain the nature of engagement with stakeholder groups. Participatory learning and action (PLA) research approaches show promise, but there has been no detailed analysis of stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis.

Objectives: To explore stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis.

Usefulness of PHQ-9 in primary care to determine meaningful symptoms of low mood: a qualitative study.

Background: Self-administered questionnaires, such as the Patient Health Questionnaire (PHQ-9), are regularly used in clinical practice to guide prescribing or to measure recovery and response to treatment. There are concerns that patients are not all interpreting the questionnaire items in the same way. Cognitive interviewing is a research technique that identifies 'interpretative measurement error' (IME).

Mental health problems of undocumented migrants (UMs) in The Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care.

Objective: To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems.

Design: Qualitative study using semistructured interviews and thematic analysis.

Participants: 15 UMs in The Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached.

Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care.

Background: Psychological therapy is effective for symptoms of mental distress, but many groups with high levels of mental distress face significant barriers in terms of access to care, as current interventions may not be sensitive to their needs or their understanding of mental health. There is a need to develop forms of psychological therapy that are acceptable to these groups, feasible to deliver in routine settings, and clinically and cost effective.

Methods: We developed a culturally sensitive wellbeing intervention with individual, group and sign-posting elements, and tested its feasibility and acceptability for patients from ethnic minorities and older people in an exploratory randomised trial.

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory.

Background: There have been recent important advances in conceptualizing and operationalizing involvement in health research and health-care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine - normalized - way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization - definition, enrolment, enactment and appraisal.

Aiming to improve the quality of primary mental health care: developing an intervention for underserved communities.

Background: The purpose of the study was to improve the quality of primary mental healthcare in underserved communities through involvement with the wider primary care team members and local community agencies.

Methods: We developed training intended for all GP practice staff which included elements of knowledge transfer, systems review and active linking. Seven GP Practices in four localities (North West England, UK) took part in the training.

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project.

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services.

The long-term impact of early parental death: lessons from a narrative study.

Objective: To explore the individual experiences of those who had experienced the death of a parent(s) before the age of 18, and investigate how such experiences were perceived to impact on adult life.

Design: An exploratory qualitative design using written (n = 5) and oral (n = 28) narratives and narrative analysis was adopted to explore the experiences 33 adults (7 men and 26 women) who had experienced parental death during childhood.

Setting: UK participants: Individuals living in the North West of England who had lost a parent(s) before the age of 18.

Developing evidence for how to tailor medical interventions for the individual patient.

We aim to answer the question: How can we develop an evidence base that will assist tailoring health interventions to individual patients? Using social theory and interview data from people living with chronic illness, we developed a new approach to analysis. Individuals were considered as emergent complex systems, adjusting and adapting within their environment and sometimes transforming. The notion of illness trajectory brought our attention to data in the interviews about the "emergent present," the current period of time when all domains of life, from across time, have expression.

A care-full diagnosis: three Vietnamese Australian women and their accounts of becoming "mentally ill".

It is often argued that Western medical responses to illness take illness out of the intimate social contexts within which illness becomes meaningful for people and that, as a result, Western medicine can often constitute an ineffective or, at worst, a disempowering response to illness. While not wishing to challenge such arguments, we seek in this article to present material that might serve as a useful caveat to them. Drawn from interviews conducted as part of an Australian study exploring cross-cultural understandings and experiences of mental illness, we present the accounts of three Vietnamese Australian women.

What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms.

Background: Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health.

Objective: To examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome.

Depression in terminal illness: the need for primary care-specific research.

Background: Palliative care research highlights depression as a common, treatable condition in patients with terminal cancer. Guidance from the European Association for Palliative Care calls for proactive screening and treatment of the disease. However, prevalence of depression among primary care patients with advanced cancer is unknown and it remains uncertain whether existing guidance is appropriate for use by GPs.

Conceptualizing psychosis in Uganda: the perspective of indigenous and religious healers.

A qualitative study, investigating the representations and explanatory models of ;madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood ;madness' as spiritual or physiological, whereas religious healers also held psychological models.

Design of a clustered observational study to predict emergency admissions in the elderly: statistical reasoning in clinical practice.

Objective: To describe the statistical design issues and practical considerations that had to be addressed in setting up a clustered observational study of emergency admission to hospital of elderly people.

Study Design And Setting: Clustered observational study (sample survey) of elderly people registered with 18 general practices in Halton Primary Care Trust in the north-west of England.

Results: The statistical design features that warranted particular attention were sample size determination, intra-class correlation, sampling and recruitment, bias and confounding.

Predicting the likelihood of emergency admission to hospital of older people: development and validation of the Emergency Admission Risk Likelihood Index (EARLI).

Objective: To develop and evaluate an evidence-based tool for predicting the likelihood of emergency admission to hospital of older people aged 75 years and over in the UK.

Methods: Prospective cohort study of older people registered with 17 general practices within Halton Primary Care Trust in the north-west of England. A questionnaire with 20 items was sent to older people aged>or=75 years.