Deterioration in mental health: towards a conceptualization based on patients' perspectives

This study explores the concept of deterioration from the perspective of patients with mental-health problems, aiming to increase our understanding of this complex phenomenon.

Participants were 15 patients in an outpatient public mental health setting. Transcribed interviews were analyzed using thematic analysis.

An overarching theme and four subthemes were identified. The main theme (an overwhelming sense of depletion from being in constant vigilance) encompasses experiences with deterioration as an ever-present potential participants had to plan for, and protect themselves from. In subtheme 1 (losing or having one's perspective changed), participants described increased symptoms, relational problems, and avoidance. In subtheme 2 (being in a state of negative emotional reactivity), participants described feeling brittle and easily negatively affected by life events. Subtheme 3 (experiencing physical and psychological pain), encompasses experiences with increased or newly emerged pain, related to psychological distress. Subtheme 4 (becoming less authentic with oneself and others), details how participants intentionally or unintentionally hide their symptoms and difficulties.

Mental health deterioration is a multifaceted concept that includes, but is not limited to symptomatic increases. Patients' overall life functioning and the fact that patients may choose to hide their symptoms must also be taken into account.