Identification of anxiety and depression in community-dwelling people with dementia: a multiperspective qualitative study

Background Symptoms of anxiety and depression are common in people with dementia but can be challenging to distinguish from other symptoms, leading to misrecognition. Aim To explore the perspectives of people with dementia, their carers and health and social care professionals (HSCPs) regarding how anxiety and depressive symptoms in community-dwelling people with dementia, are identified and conceptualised. Design and Setting Qualitative study with people with dementia and anxiety/depression, their carers and primary care HSCPs in England. Method Semi-structured and group interviews were conducted with 56 participants face-to-face, via phone/video call. Interviews were audio-recorded, transcribed and data analysed using reflexive thematic analysis. Results Two themes and six subthemes were developed. The first theme, 'Factors informing identification and diagnosis' described the challenges of distinguishing symptoms of anxiety, depression or dementia. All participant groups felt similarity of anxiety and depressive symptoms with cognitive impairment can delay dementia diagnosis. HSCPs and carers felt that as dementia progressed, observed changes in behaviour and emotional responses over time could aid recognition. Anxiety and depression were often attributed to dementia by HSCPs and carers, but other comorbidities can contribute, and other causes should be explored. All groups felt contextual factors such as personality could influence presentation of anxiety and depression. The second theme was 'stigma of help-seeking'. All groups felt help-seeking was affected by cultural influences e.g., ethnicity, denial and masking of symptoms. Conclusion, Identification of anxiety and depression in dementia is complex. Consideration of factors such as changing behaviours, co-morbidities, culture and stigma may aid recognition.