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Illness narratives and preferences for treatment among older veterans living with treatment-resistant depression and insomnia.

Gebara MA, DiNapoli E, Hamm ME, Rodriguez KL, Kasckow JW, Lederer LG, Bramoweth AD, Karp JF. Illness narratives and preferences for treatment among older veterans living with treatment-resistant depression and insomnia. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists. 2020 May 1; 32(2):81-89.

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BACKGROUND: Despite the prevalence of comorbid late-life treatmentresistant depression (LLTRD) and insomnia in older adults, there is a gap in the literature describing patient factors, such as patients'' beliefs about their illnesses and preferences for treatment, that can facilitate recovery. Therefore, we explored the perceptions and treatment preferences of older veterans with LLTRD and insomnia. METHODS: Semi-structured interviews were completed with 11 older veterans. A thematic analysis of the interviews was conducted. RESULTS: Four main themes were identified: 1. Insomnia and medical problems were considered to be significant contributors to depression, which was defined by low mood and anhedonia; 2. "Overthinking" was thought to be a cause of insomnia; 3. Participants'' preference for psychotherapy was driven by their past experiences with therapy; and 4. Participants viewed patient education as a facilitator for compliance. CONCLUSIONS: Older veterans with LLTRD and insomnia have a preference for behavioral interventions. However, they lack knowledge about available treatment options, such as behavioral interventions for sleep that can improve both their sleep and mood while being a good fit with their illness narratives, such as "overthinking." There is a need for patient education, which should be offered early and often during treatment.

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