An exploration of the conditions for deploying self-management strategies: a qualitative study of experiential knowledge in depression

Abstract

Background Living with recurrent, and/or chronic depression requires long-term management in addition to active coping on a day-to-day basis. Previous research on long-term management, and coping with depression mainly focused on identifying self-management strategies. However, research on the conditions for deploying self-management strategies in depression is lacking. By means of exploring the development of experiential knowledge in depression, and its relation with coping with depression, this study aims to gain insight into the conditions for deploying self-management strategies. Methods In the current qualitative study, individual pathways to recovery, living with depression, and recurrence risk were assessed, including but not limited to long-term management. ‘Experiential knowledge’, which can be defined as patients’ unique knowledge and own lived experiences in facilitating and debilitating factors in the recovery process and coping with the disorder, was used as a sensitizing concept. Thirteen semi-structured interviews were conducted with individuals who experienced at least two depressive episodes and were currently in (partial) remission, plus two deviant cases were interviewed to check for saturation. Until saturation was achieved, participants were purposively selected to include diverse perspectives on coping with depression. Data were analysed using a narrative research method. Results The results show that deploying self-management strategies are an integral part of ‘experiential knowledge’. The evolvement of experiential knowledge can be seen as a cyclical process of the main themes that were identified as relevant when coping with depression: introspection, empowerment, self-management strategies, and external moderators of the environment. The identification of supporting and impeding factors in coping with depression from a patient perspective might increase a sustainable use of self-management strategies. Conclusion These results highlight the need for an individualised holistic model of coping with depression, both in research, and in practice. By means of integrating experiential knowledge in this holistic approach, the conditions for deployment of self-management strategies in depressive patients can be specified.

A Newly Developed Online Peer Support Community for Depression (Depression Connect): Qualitative Study

“…According to most participants, the autonomy in choosing how they engaged in Depression Connect was a core advantage of online peer support, distinguishing it from other forms of offline peer support or formal care. When faced with (recurrent) depression, people often feel compelled to keep functioning well in daily life, being a good spouse, mother or father, employee, friend, or even patient [ 51 ]. When seeking support online, they do not feel this pressure and can let themselves be guided by their current needs.…”

“…We used a hybrid approach [ 53 ] combining deductive and inductive reasoning. In the theoretical context of our larger project [ 51 ], we created a guiding framework [ 54 ] based on an inventory of experiential knowledge and the relevant literature on empowerment to deduce all relevant factors involved in the broad and complex interplay of depression ISGs [ 14 ]. We applied thematic analysis [ 54 ] to identify, examine, and gain insight into the patterns of predetermined themes.…”

“…Both authors have a master’s degree in social sciences and are specifically trained and experienced in qualitative research methods. They had created a topic list, building upon the first exploratory study [ 51 ], the existing literature, feedback from the project group members (1 psychiatrist, 3 experiential experts on depression, and 2 senior researchers) and an exploratory interview with a Depression Connect member. As shown in Textbox 1 , the following topics guided the interviews: (1) forum use (why, when, and how), (2) Depression Connect benefits and downsides, (3) Depression Connect working mechanisms, and (4) (relationship with) the use of other forms of formal or informal depression support and care.…”

“…Dominant and less-important elements in the data were determined to allow selective coding. At that point, the inductive and deductive approaches were combined by harmonizing the category system (based on open and axial coding) with the predetermined concepts (eg, empowerment) [ 51 ]. Categories were thus organized and integrated to uncover relationships between user engagement, Depression Connect appreciation, and the working mechanisms Depression Connect members had proposed.…”

“…In a first exploratory study, we interviewed patients with recurrent and chronic symptoms of depression to gauge their experiential knowledge about coping strategies. The results suggested that gains in experiential knowledge mainly pertained to three intrapersonal factors: introspection, empowerment, and self-management strategies [ 51 ]. Subsequently, to facilitate the exchange of personal experiences, we developed “Depression Connect”— a closed, moderated platform providing online peer support for individuals living with depression.…”