BMC psychiatry · 2026
Understanding and evaluation of the concept of "palliative psychiatry" among service users with chronic and treatment-resistant depression: a qualitative study of service user perspectives.
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Gieselmann Astrid, Potthoff Sarah, Cole Robin, Otte Christian, Wingenfeld Katja
Аннотация
BACKGROUND: The concept of "palliative psychiatry", which proposes a shift from curative goals to prioritizing quality of life for people with severe and persistent mental illness when remission seems unattainable, has been proposed to improve care for people with severe and persistent mental illness, yet service users' perspectives, particularly in the context of depression, are underexplored. The objective of this study is to explore how individuals with chronic depression understand and evaluate a concept of "palliative psychiatry".
METHODS: We conducted semi-structured interviews with 19 adults with chronic depression (age range 21-79 years; 63% women), many of whom had undergone intensive treatments such as electroconvulsive therapy or ketamine, recruited from three specialized wards in Berlin, Germany. Data were analyzed with thematic analysis, which is a systematic method for identifying, analyzing, and reporting patterns (themes) within qualitative data.
RESULTS: Thematic analysis revealed two main thematic patterns with several subcategories. The two main thematic patterns were "benefits and risks" as well as "needs and wishes". Anticipated benefits included relief from perceived pressure to achieve remission and the avoidance of the psychological distress associated with repeated treatment failures. Risks included stigma linked to the term "palliative," fear of premature transition away from potentially curative care, and loss of hope. Concrete service users' needs and wishes included ongoing support without abandonment, care settings with a less institutional atmosphere, and transparent communication.
CONCLUSIONS: Service users with chronic depression see benefits but also risks in a palliative orientation when curative goals appear unattainable, provided it does not imply therapeutic withdrawal. Potential future conceptual refinement of "palliative psychiatry" will require safeguards against premature categorization and careful terminology.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: We conducted semi-structured interviews with 19 adults with chronic depression (age range 21-79 years; 63% women), many of whom had undergone intensive treatments such as electroconvulsive therapy or ketamine, recruited from three specialized wards in Berlin, Germany. Data were analyzed with thematic analysis, which is a systematic method for identifying, analyzing, and reporting patterns (themes) within qualitative data.
RESULTS: Thematic analysis revealed two main thematic patterns with several subcategories. The two main thematic patterns were "benefits and risks" as well as "needs and wishes". Anticipated benefits included relief from perceived pressure to achieve remission and the avoidance of the psychological distress associated with repeated treatment failures. Risks included stigma linked to the term "palliative," fear of premature transition away from potentially curative care, and loss of hope. Concrete service users' needs and wishes included ongoing support without abandonment, care settings with a less institutional atmosphere, and transparent communication.
CONCLUSIONS: Service users with chronic depression see benefits but also risks in a palliative orientation when curative goals appear unattainable, provided it does not imply therapeutic withdrawal. Potential future conceptual refinement of "palliative psychiatry" will require safeguards against premature categorization and careful terminology.
CLINICAL TRIAL NUMBER: Not applicable.