Supplementary Material for: What helps and hinders recovery from depression? A systematic review and qualitative evidence synthesis of patient-identified recovery factors

Introduction: Depression is a common mental disorder with often persistent consequences. Even after adequate treatment, recovery may be far from optimal. To enhance outcomes, we aimed to identify and synthesize factors that depressed adults themselves perceived as facilitating or hindering recovery. Methods: We searched PubMed, PsycINFO, and SocINDEX (last search: February 2, 2025), screened reference lists and consulted experts. Eligible studies used a qualitative design, published in English or Dutch since 1980, and explored recovery factors in adults (≥18 years) with depression. Results: From 4,872 records, 3,394 were screened on title and abstract, and 122 on full text. Twenty-seven articles were eligible and included in the qualitative evidence synthesis. These articles described the experiences with recovery from depression of 939 individuals. Most studies were conducted in Europe (N=11), followed by North America (N=7), Asia (N=6), Australia (N=5), and South America (N=2). Eight overarching themes emerged: (1) Social connections, (2) Reconstructing the self, (3) Autonomy, (4) Professional support, (5) Self-management strategies, (6) Physical health, (7) Instrumental facilitators/barriers, and (8) Temporal dimensions. We present an overview of the relative importance of factors and propose a conceptual model illustrating the interconnectedness of themes. Conclusion: Recovery from depression involves a diverse range of interconnected factors. While professional treatment is considered valuable, various other factors also influence individuals’ recovery. Our findings underscore the need for an integrated and person-centered approach that combines therapeutic support with personal capacities, self-management strategies, and contextual aspects, emphasizing relational quality, self-reflection, and open dialogue, to optimize subjectively experienced recovery.

引言：抑郁症是一种常见的精神障碍，往往会造成持久的不良后果。即便接受了规范治疗，患者的康复效果仍可能远未达到理想状态。为改善康复结局，本研究旨在识别并综合抑郁成年患者自身所感知到的、对康复具有促进或阻碍作用的各类因素。方法：本研究检索了PubMed、PsycINFO及SocINDEX数据库（末次检索时间：2025年2月2日），同时筛选纳入文献的参考文献列表并咨询相关领域专家。纳入标准为：采用质性研究设计、1980年以来以英语或荷兰语发表、针对18岁及以上成年抑郁症患者探索其康复影响因素的研究。结果：本研究从4872条文献记录中，首先通过标题与摘要筛选出3394篇文献，进一步通过全文阅读筛选出122篇，最终纳入27篇符合标准的文献用于质性证据综合。这些文献共涉及939名抑郁症患者的康复经历。研究开展地域以欧洲居多（N=11），其次为北美（N=7）、亚洲（N=6）、澳大利亚（N=5）及南美（N=2）。本研究最终提炼出8个核心主题：（1）社会联结（Social connections），（2）自我重构（Reconstructing the self），（3）自主性（Autonomy），（4）专业支持（Professional support），（5）自我管理策略（Self-management strategies），（6）身体健康（Physical health），（7）工具性促进/阻碍因素（Instrumental facilitators/barriers），（8）时间维度（Temporal dimensions）。本研究对各类因素的相对重要性进行了概述，并提出了一个概念模型以阐明各主题间的内在关联。结论：抑郁症康复涉及一系列相互关联的多样化因素。尽管专业治疗被认为具有重要价值，但其他多种因素同样会影响患者的康复进程。本研究结果强调，需采用整合式、以患者为中心的干预方案，将治疗支持与个体能力、自我管理策略及背景环境因素相结合，同时重视关系质量、自我反思与开放沟通，以优化患者主观感知的康复效果。