Navigating the Depression Care Network in Primary Health Care: A Qualitative Study of Older Adults with Depression and Family Caregivers in Thailand

Background: Primary healthcare (PHC) is essential for depression management. However, system navigation remains under-explored in the lived experiences of service recipients in non-Western aging contexts. Objective: To explore experiences, perceptions, and barriers among Thai older adults with depression and family caregivers navigating the PHC depression surveillance network. Methods: Guided by COREQ, this qualitative study spanned six geographic regions in Thailand. Using purposive sampling within a multiphase framework, semi-structured face-to-face interviews were conducted with 60 older adults diagnosed with depression and 12 family caregivers (N = 72). Data were transcribed verbatim and analyzed using qualitative content analysis supported by componential analysis principles. Results: Navigation unfolded across three interconnected domains: (1) Recognizing Emotional Distress: Older adults framed symptoms as physical ailments or normal aging, whereas caregivers identified behavioral withdrawal and functional decline. (2) Interacting with PHC Services: Initial screening by Village Health Volunteers and nurses via 11Q tools enabled system entry, but interactions were constrained by limited consultation time, stigma, and fragmented communication. (3) Sustaining Care Continuity: Referral disconnects between subdistrict health-promoting hospitals and community hospitals’ psychiatric units shifted the burden onto caregivers to maintain treatment adherence without adequate psychosocial support. Conclusions: Navigating primary depression care involves multidimensional challenges. Strengthening community-based care requires transforming routine screening into continuous, person- and family-centered surveillance, streamlining referral pathways, and formally empowering family caregivers as care partners.