Self-Management of Depression and Medical Illness

OBJECTIVE(S): This study seeks to use a theoretically-driven, systematic method to adapt group self-management programs developed and proven effective for persons with chronic medical illness for patients who also have depression.

METHODS: First, we use two existing high quality datasets of group self-management trials (the Chronic Disease Self-Management Program (CDSMP) and the Spanish Arthritis Self-Management Program (SASMP)), to examine the depression and medical outcomes of patients with co-morbid conditions and to explore predictors of response and intervention mechanisms, guided by an adapted conceptual model of the interactions between depression and medical illness. Second, guided by these results, we collect qualitative data from depressed persons in self-management groups and their group leaders to explore unmet needs and potential program adaptations. Third, an expert panel uses findings to adapt the programs as necessary and develops a manualized program protocol in preparation for a future randomized trial.

FINDINGS / RESULTS: Final models for the secondary data analyses are currently being elucidated. Initial analyses of the CDSMP and SASMP indicate that depressive symptoms are common among group participants. Among CDSMP participants, the mean baseline Center for Epidemiologic Studies Depression Scale (CESD) score was 16.218 (SD 9.384) for intervention patients and 14.866 (SD 9.817) for controls (scores ?16 depressive disorder). Differences in baseline scores between both groups were not significant. Among SASMP participants, the mean baseline CESD score was 20.764 (SD 12.256) for intervention patients and 18.949 (SD11.534) for controls; half of the sample had a baseline score ? 19. Among the quartile of subjects in the SASMP with the highest baseline CESD scores (mean score 36.38 (SD 5.43) for intervention patients, 35.69 (SD 6.39) for controls), those in the intervention were significantly more likely to experience an improvement in depressive symptoms (t=-4.47, p=<.0001). Compared to those without depressive symptoms, subjects with CESD scores ? 16 in both the CDSMP and SASMP appeared to have better medical outcomes.

STATUS: The first stage secondary analyses are currently being completed and planning is underway for the second stage, in which self-management groups will be done with persons who have depression and medical illness.

IMPACT: This study aims to make both scientific and public health contributions. Our study will contribute to a conceptual understanding of the relationship between depression and physical illness. The study will also inform the science of program adaptation by developing a systematic, theoretically-driven approach for adapting patient self-management group programs developed and proven effective for patients with chronic medical illness for patients who also have depression. Such an adapted program may address an important public health need by creating an effective, low-cost, sustainable, culturally relevant, psychosocial treatment for primary care patients with depression and chronic medical illness. These programs would be responsive to recommendations by the Institute of Medicine to improve the quality of health care in 20 priority areas, including both depression and patient self-management, to develop culturally appropriate education programs for minority populations, and to develop patient-centered healthcare interventions. Such programs also answer calls for developing ways to integrate mental health services into primary care, for primary care interventions that address multiple chronic conditions, and for conducting practical trials that are relevant to clinical practice.