The World Bank and the World Health Organization have predicted that coronary heart disease (CHD) and depressive disorder will be the two top causes of global health burden and disability by 2020 . Estimates of the prevalence of major depression in patients with CHD range from 15% to 23% as compared to a general population prevalence of 4.6% [2, 3]. Co-morbid CHD and depression is associated with a 2-fold increase in cardiac and all-cause mortality [4, 5].
There has been increasing recent interest in multimorbidity and the bi-directional relationship between conditions such as coronary heart disease and depression in primary care . Gunn and colleagues  have demonstrated from the Melbourne DIAMOND study, the increased prevalence of depression in a wide range of long term physical conditions in primary care. They found an increased likelihood of depression with increasing multimorbidity which appeared to be mediated by associated functional limitation and self rated health. Bhattarai and colleagues  also found an increasing prevalence of depression and physical comorbidity was associated with increased health care use and resource costs. Guthrie and colleagues  suggest integrating relevant single condition guidelines to make them more relevant for managing multimorbidity.
In contrast, recent qualitative work, using psychological models, has looked at the impact of multimorbidity on patient representations of their individual conditions as well as the representation of multimorbidity itself . The authors concluded that such representations need to be incorporated into the design and delivery of multi-facetted interventions to modify health behaviours and to improve outcomes. Coventry and colleagues  have studied the barriers to managing depression in people with long term conditions in primary care and found that in partnership with patients, depression was often normalised by practitioners as an understandable reaction to physical illness. Furthermore, the current Quality and Outcomes Framework promoted a reductionist approach to case finding of people with depression and CHD. Once identified, practitioners can feel unsure how to frame discussions with patients around the topic of depression in coronary heart disease .
For the UPBEAT-UK qualitative study, reported on here, the aim was to explore patients’ own experiences, priorities and meaning making to inform the design of a nurse led personalised, case management intervention. Studies, such as COINCIDE  utilised psychological models to assess whether a collaborative care approach, using CBT based IAPT providers, could improve patient centred outcomes. In contrast the UPBEAT-UK study adopted an inductive, patient centred approach that could capture a broad range of concerns. We did not wish to employ existing psychological models or other theoretical approaches that may have limited the scope of the findings.
This study aimed to explore (i) primary care (PC) patients’ perceptions of links between their physical condition and mental health, (ii) their experiences of living with depression and CHD and (iii) their own self-help strategies and attitudes to current PC interventions for depression.
Bexley and Greenwich ethics committee gave ethical permission for the study (reference 07/H0809/38), and approval was obtained from NHS trust research governance offices in South East and South West London. The Researcher (RS) consented the participants.