Recovering from Depression

Submitting Institution

University of Westminster

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Public Health and Health Services


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Summary of the impact

Our research elaborated for the first time how people actually go about recovering from depression. The work moved the field on from rhetoric advocating a `recovery ' approach, to elucidating what that practice actually entailed for patients. Amongst other contributions, we worked out the signposts involved in recovery, the `tools' used, and the potential of patient stories to contribute to recovery. This work had a number of direct impacts with consumers, practitioners, charities and policy makers. The National Institute of Clinical Excellence incorporated our work extensively into their guidance on depression (2010), and consumers `shared' it globally e.g. via Facebook.

Underpinning research

The initial data was collected in 2003-04 by Professor Damien Ridge as a senior researcher (University of Oxford). However, the specific recovery analysis and concepts were developed at the University of Westminster by Ridge from 2006 onwards. The project at Westminster was the first to rigorously analyse systematically collected narratives specifically about how people attempt to recover from depression. The usual definition of recovery is "building a meaningful and satisfying life, as defined by the person themselves..." (Shepherd, Boardman et al. 2008). Although recovery as a concept in mental health was advocated decades ago (Anthony 1993), and is now used by government authorities like the NHS, previously, scant attention was paid to fleshing out what this optimistic rhetoric actually meant for people with depression.

Currently, the main influential recovery research was published in a well cited paper (Ridge and Ziebland, 2006). In this work we specially showed that recovery variously involved telling a better story about oneself; adopting a `recovery' attitude; using `recovery tools' (e.g. medication, counselling, sharing peer stories); creating personal space to develop insights; needing to engage with `authentic' subjectivities of the self; coming to terms with a `false self'; and re-writing the story about depression story as less detrimental than previously imagined (e.g. as a necessary wake-up call, a spiritual quest, a biochemical change in the brain). The research also revealed that `coming out' for those with depression (and as part of recovery) shared the language and tasks that sexual minorities advocated from the 1960s (Ridge & Ziebland, 2012), e.g. feeling vaguely different as a child; needing to dis-identify with depression and recast it as commonplace or advantageous; contending with feelings of shame and pride; and coming out of the depression `closet'). We also found that recovery for men frequently involved a re-assertion of a dominant masculinity (Emslie, Ridge et al. 2006), e.g. by re-casting depression as a heroic battle, and less commonly by challenging masculine hegemony, e.g. by celebrating sensitivity and creativity.

Ridge is now applying these narrative and recovery concepts more widely. He was subsequently funded to investigate the role of meditation in men's distress; how to alleviate distress in men in primary care settings; how those ageing with HIV cope in terms of their mental health (MRC/ESRC), as well as understanding the role of Western herbal practice in women's distress (MMDB Charity). Ridge is now collaborating with researchers at the University of Oxford (Sue Ziebland) to understand how patients morally construct anti-depressant use in terms of their recovery. He is also pooling his data with new data from Australia to understand the interface between depression, work and recovery (Prof Renata Kokanovic, Monash University, Melbourne).

References to the research

Ridge, Damien T. & Ziebland, S. (2006). The old me could never have done that: How people give meaning to recovery following depression. Qualitative Health Research, 16, 8, 1038-1053.

 
 
 
 

Ridge, Damien T. (2009) Recovery from Depression Using the Narrative Approach. Jessica Kingsley Publishers, London, UK. ISBN 9781843105756

Ridge, Damien T. and Ziebland, Sue (2012) Understanding depression through a 'coming out' framework. Sociology of Health and Illness, 34 (5). pp. 730-745.

 
 

Lomas, Timothy and Cartwright, Tina and Edginton, Trudi L. and Ridge, Damien T. (2012) I was so done in that I just recognized it very plainly, "You need to do something"': men's narratives of struggle, distress and turning to meditation. Health, OnlineFirst . ISSN 1363-4593

 

Ridge, Damien T. and Emslie, Carol and White, Alan (2012) Understanding how men experience, express and cope with mental distress: where next? Sociology of Health & Illness, 33 (1). pp. 145-159.

 

Emslie, Carol and Ridge, Damien T. and Ziebland, Sue and Hunt, Kate (2006) Men's accounts of depression: reconstructing or resisting hegemonic masculinity? Social Science & Medicine, 62 (9). pp. 2246-2257.

 
 
 
 

Grants

• £142,000. Ridge, D. and Peters, D. for `Men's stress and distress clinic', funded by Nelsons, 2012-2014.

• £95,554. Green, J., Ridge, D., Whitehouse, J. for `How women experience herbs and herbal practice for distress', funded by the Make My Day Better Charity. 2011-2015

• £221,004 for Experiencing and Managing HIV/AIDS in Later Life. Funded by the Medical Research Council/Economic and Social Research Council's Life Long Health and Wellbeing scheme. Rosenfeld, D., Ridge, D., Anderson, J., and Catalan, J. 2011-2013

• Ridge, D. £70,000 for `Black and minority ethnic carers and mental health', funded by the Dept. of Health, 2007-2008.

Details of the impact

The National Institute of Clinical Excellence (NICE) subsequently adopted Ridge & Ziebland's (2006) recovery research extensively into their guidance on the treatment and management of depression in adults in the UK (2010), see:
http://www.nice.org.uk/nicemedia/live/12329/45896/45896.pdf. More than 10 pages of this NICE guidance are devoted to Ridge's research on depression and recovery. More than this, the recovery work was widely taken up by the consumer mental health movement, and is summarised or reproduced in full on many hundreds of consumer and information websites throughout the world (a Google search for the Ridge & Ziebland journal paper turns up 15,000 hits). For example, the award winning `Working Together' service user organisation has reproduced Ridge & Ziebland's research in full (see http://www.workingtogetherforrecovery.co.uk/recovery_library.htm) so that consumers can benefit. Further, key charities and health sites have commissioned Professor Ridge to translate his recovery findings for consumers (e.g. see CALM (Campaign Against Living Miserably): http://www.thecalmzone.net/help/issues/depression/ and the Healthista health channel:
http://www.healthista.com/mind/how-to-spot-depression-in-man/).

In terms of professional practice, many commentators noted that the work moves the field beyond the current rhetoric advocating a general `recovery approach' (see below). In terms of specific contribution to insight, McKenzie (2009) notes that the main value of the work is the `scholarly' approach taken to `establishing the therapeutic potential of narrative.' McKenzie (2009) notes that while the NHS requires mental health practitioners to adopt a recovery model in their work, `[Ridge] provides significant signposts as to what that practice might contain.' Therapy Today called the book `an excellent addition to the literature on this subject' (Townsend 2009). One practitioner wrote "This book opened new horizons to the area of depression"
(http://jameswoodward.sdnet.co.uk/review-ridge.htm). Writing in Pulse magazine for GPs, Dr Clare Etherington, said of the work, "essentially hopeful, enjoyed reading... stimulated thought about everyday practice." The book was given 5 out of 5 stars by the practice-based Nursing Standard (Vol 26, no. 47, 2012). Nursing Standard subsequently commissioned and funded Ridge (2012) to translate his findings into a step-by-step guide for nurses, describing how nurses could operationalize recovery for patients with depression (Nursing Standard, 26 (47). pp. 35-40. ISSN 0029-6570).

Ridge is regularly invited to talk to, and write for, consumers directly about how they can recover from depression. So for example, he talked directly to users on the Sky TV `ChrissyB Show' about how they could recover based on his research. The ChrissyB show regularly has over 10,000 viewers, and there are over 260 views of his Sky `recovery from depression' video on Youtube (http://www.youtube.com/watch?v=it79DRfuXB8). In addition, Ridge regularly talks about recovery, translating his research, for his popular Huffington Post blog. So when Ridge disseminated his research on recovery via his own blog, the public avidly shared it: 207 people shared it on their Facebook page, a further 620 people shared it by `liking' the page on Facebook, and 63 people tweeted the article amongst their networks, effectively ensuring that the research went global
(http://www.huffingtonpost.co.uk/professor-damien-ridge/depression-creating-hope_b_2997084.html).
The CALM recovery page discussed above was also shared by 132 people via Facebook, and is read by many thousands more every month. An event, `Living or Just Surviving,' was held on the 8th of October 2013 at the University of Westminster, and this translated the recovery research for a broad audience of 150 public attendees (Eventbrite statistics). The CALM charity subsequently made Professor Ridge a Trustee, acknowledging the very high value of his recovery and mental health work to the public, and in particular its value in helping suicidal men, many of whom are depressed.

McKenzie, R. 2009. Book Review: Recovery from Depression Using the Narrative Approach. Scottish Journal of Healthcare Chaplaincy 12 (2):65.

Townsend, Jackie. 2009. Book Review: A narrative approach to depression. Therapy Today 22 (6).

Sources to corroborate the impact