Depression, Suicide Risk, and Care Approaches among Patients with Chronic Illnesses in the Nakhonchai Burin Region: A Qualitative Study

Abstract

Patients with chronic illnesses constitute a high-risk group for depression and suicide. This qualitative study aimed to explore the situation, problems, and needs related to the care, support, and prevention of depression and suicide risk among patients with chronic diseases in the Nakhonchai Burin region of Thailand. The sample was comprised of 208 participants, including patients with chronic illnesses, caregivers, village health volunteers, and healthcare personnel from Nakhon Ratchasima, Chaiyaphum, Buriram, and Surin provinces. Data were collected through in-depth interviews and focus group discussions and analyzed using content analysis. The findings revealed that most patients with chronic illnesses in the community were older adults with multiple comorbidities and prolonged illness duration. The prevalence of depression was 10.23% and 5.93% were identified as being at risk of suicide. Key factors associated with depression and suicide risk included feelings of worthlessness and perceived burdensomeness, stress related to physical limitations and lifestyle changes, anxiety about disease complications and prognosis, and insufficient social support.
Regarding the service system, although policies and screening tools (2Q and 9Q) were implemented, their effectiveness was constrained by patients’ reluctance to disclose symptoms, limited mental health competencies among healthcare personnel and village health volunteers, and heavy workloads. Consequently, care remained predominantly focused on physical conditions, while mental health support was not systematically integrated, resulting in a gap between the existence of screening systems and their practical outcomes in identifying and assisting at-risk individuals. In conclusion, patients with chronic illnesses in community settings demonstrate significant psychological vulnerability. Strengthening the capacity of caregivers and healthcare personnel is essential to promote holistic care that integrates both physical and psychosocial dimensions.