'We're all doing different things' - exploring primary care practitioners' perspectives of managing distress: a qualitative study

BACKGROUND: Distinguishing emotional distress from mental health problems such as anxiety and depression can be difficult for clinicians. Both commonly present and are managed in primary care. There are likely to be important differences in the management of emotional distress compared with anxiety and/or depression, but the current nature of assessment and management is unclear. AIM: To explore how emotional distress is understood and how people are managed by a range of practitioners in primary care settings in the UK. DESIGN AND SETTING: A qualitative study using semi-structured interviews with primary care practitioners in the UK. METHOD: Online interviews were conducted with practitioners who directly assess patients with mental health symptoms, including GPs, nurse practitioners, social prescribers, and mental health practitioners. Recruitment was via a digital poster circulated by research delivery networks. Interviews covered how practitioners understood and identified distress, the support provided to patients, and challenges assessing and managing emotional distress. Verbatim transcriptions were analysed using an inductive thematic approach. RESULTS: In total, 29 interviews were conducted and four themes were developed in collaboration with the wider team, including public contributors: the multifaceted nature of distress; 'We're all doing very different things'; managing and understanding distress is challenging; and demedicalising distress in the face of increasing societal pressures. Complexity was driven by the wide-ranging professionals involved, complex patient circumstances, systemic challenges, and societal contexts. CONCLUSION: Identifying and managing emotional distress is complex, variable, and challenging. Complexity appears to be increasing through the systemic challenges and range of professionals involved.