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Understanding cognitive dysfunction in depression: perspectives and practices of UK health and social care
Amirah Akhtar1, Emmanuel Nwofe2, Shabana Shafiq2
1Department of Applied Dementia Studies, University of Bradford, Bradford, UK a.akhtar46@bradford.ac.uk.
Objective:
To explore how health and social care professionals (HSCPs) in the UK conceptualise and respond to cognitive dysfunction in depression, including its potential long-term implications for brain health and dementia risk.
Design:
A qualitative, semi-structured interview study. Data was analysed using a code-book approach to thematic analysis.
Setting And Participants:
The study was conducted in the UK, with HSCPs from diverse professional backgrounds including general practitioner, psychology, psychiatry, mental health nursing, psychological well-being practitioner and occupational therapy. A total of 12 participants were recruited via purposive and convenience sampling.
Results:
Three master themes were developed, (1) Cognitive dysfunction in depression, (2) Persistence of cognitive dysfunction and (3) Depression and dementia risk. HSCPs expressed challenges in screening for cognitive dysfunction in depression, particularly as dementia-related screening tools were used which may not be sensitive enough to detect depression-related cognitive deficits. A number of potential explanations were reported as to why cognitive dysfunction may persist after mood symptoms have lifted. These included substance misuse, role of education, neurological conditions and depression as a prodrome to dementia. Depression as a potential risk factor for poorer brain health in the context of dementia risk reduction was not communicated in clinical settings to service users. Barriers to communication included lack of evidence base on depression as a potential risk factor, as well as lack of guidance on communication practices in the context of mental health issues.
Conclusions:
Cognitive dysfunction in depression is a complex phenomenon and remains under-explored. Challenges around identification and screening indicate a need for validation studies of cognitive screening measures for use in mood disorders, as well as pilot, acceptability and feasibility trials of interventions targeting cognitive functioning in mood disorders. Mixed-methods research is warranted to understand whether guidance on communicating depression as a risk factor for brain health is required and/or justified.
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