A proverbial double-edged sword

Abstract

The notion of family and carer involvement appears throughout European mental health policy and guidelines. However, it has been noted that carer involvement policy may derive from a responsibilization agenda rather than from evidence that it genuinely supports re- covery. We review qualitative research on family life with depression from the perspective of people with depression. Studies were included if they elicited accounts from adults with a professional diagnosis of depression. Nineteen studies were included which incorporated the experiences of 493 adults with depression. A metasynthesis of findings from these stu- dies is discussed within three themes: family issues and depression interact; family support as a double-edged sword; benefits and limitations of psychosocial interventions. Findings reveal a complex inter-relationship between family roles, relationship dynamics, gender, culture and attitudes towards depression. Family involvement in primary care and medical settings can be a double-edged sword and the perceived benefit may depend on the extent to which family perspectives on treatment fit with the depressed person’s understanding of their depression as medical or psychosocial. Psychosocial interventions for individual cli- ents have several limitations in terms of improving family relationships while family-based group interventions may be more beneficial, depending on the engagement of the family and the partner in particular. The review findings emphasise the complexity of family life with depression indicating that the requirement for ‘carer involvement’ as simplified in cur- rent policies and guidelines is naïve policy at best and that family or couple psychosocial interventions may often be more appropriate.