Exploring the phenomenology of clinical and non-clinical depression: a Q-methodological study

The lived experience of depression is taken as a starting point for this research which aims to document and explore the variety of experiences of depression among a diverse sample of participants who have been diagnosed with and/or self-report as having had an experience or experiences of depression, either currently or in the past. Using Q-methodology and drawing on social constructionism and existential-phenomenology (particularly the work of Kenneth Gergen, Rom Harré and Martin Heidegger), I ask the questions ‘How do participants experience (clinical and non-clinical/self-identified) depression? How do participants’ experiences resemble or differ from established psychiatric and clinical psychology accounts of depression and how might the findings be relevant to existential counselling psychology practice? There were two phases to this empirical study. Firstly, a preliminary focus group study was conducted using a ‘clinical’ and a ‘non-clinical’ group and thematic analysis was used to analyse the data which provided information and materials for the development of the concourse of statements used in the main sorting task. Secondly, the main Q-methodological study required 46 participants to sort (online) a series of 58 experiential statements along a continuum ‘most like me when I’m depressed’ to ‘least like me when I’m depressed.’ Nine of these statements were based upon the current DSM-5 diagnostic criteria for major depression. Principal component’s factor analysis produced eight interpretable factors which represent eight different (but shared) experiences of depression as follows; 1) ‘Clinical’/suicidal depression, 2) The ‘blues’/overcoming loss and bereavement, 3) Anxious/’anti-clinical’ depression, 4) Emotionally devoid/isolated depression, 5) Sadness and loss/surviving depression, 6) Alienated/helpless depression, 7) The ‘blues’/surviving through self-reliance, 8) Loss of meaning/depression as part of the cycle of life. These different experiences are explicated in detail and in relation to the placement of the DSM diagnostic statements. Only one of the factors showed a strong similarity to the DSM criteria while all the other factors revealed experiences that may not be captured by those measures. The results are considered in relation to social constructionist critiques and existential-phenomenological philosophy. Finally, the relevance of the findings for existential-phenomenological counselling psychology practice is discussed.