Organized Self-Management Support Services for Chronic Depressive Symptoms: A Randomized Controlled Trial

Ludman, Evette; Simon, Gregory E.; Grothaus, Louis C.; Richards, Julie; Whiteside, Ursula; Stewart, Christine

doi:10.1176/appi.ps.201400295

Cited by 22 publications

(64 citation statements)

References 59 publications

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“…The follow-up period was longer in the ZemCAD intervention. Ludman et al [39] focused on patients with chronic depression, but had a longer, more intensive treatment than the ZemCAD intervention. All three studies had group settings and a peer support component was present.…”

Section: Discussionmentioning

confidence: 99%

“…Groups enable patients to better withstand alienation and crisis because of the connectedness and social support [42]. Peer support is proven to be supplementary in various self-management programs [38, 39, 43]. Interactions with peers may enhance patients’ belief in their own ability to self-manage their lives, thus increasing perceptions of recovery and lowering feelings of anxiety and depression.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders on quality of life, symptoms, and empowerment: results of a randomized controlled trial

Zoun

Koekkoek

Sinnema³

et al. 2019

BMC Psychiatry

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BackgroundAnxiety and depressive disorders are common mental disorders. A substantial part of patients does not achieve symptomatic remission after treatment in specialized services. Current care as usual (CAU) for these patients consists of long-term supportive contacts. Termination of CAU is often not considered to be an option due to persistent symptoms, a low level of functioning, and the absence of further treatment options. A new intervention, ZemCAD, offers a program focused on rehabilitation and self-management, followed by referral back to primary care.MethodsThis multicenter randomized controlled trial was carried out in twelve specialized outpatient mental health care services in the Netherlands. Consenting and eligible patients were invited for the MINI interview and the baseline questionnaire. Assessments were done at 6 (T1), 12 (T2) and 18 (T3) months post baseline. We used linear mixed model analysis (LMM) to ascertain the effectiveness of the ZemCAD group relative to the CAU group on quality of life, symptom severity and empowerment.ResultsIn total 141 patients were included. The results at 18-month follow-up regarding to quality of life and symptom severity, showed no significant differences between the ZemCAD group and the CAU group, except on the ‘social relationships’-domain (d = 0.37). With regard to empowerment a significant difference between both groups was observed in the total empowerment score and one empowerment dimension (d = 0.45 and d = 0.39, respectively). After the ZemCAD intervention, more patients went from specialized outpatient mental health services back to a less specialized health care setting with less intensive treatment, such as primary care.ConclusionThe findings in this study suggest that patients with chronic and treatment-resistant anxiety and depression using the ZemCAD intervention improve on empowerment but not on symptom severity or quality of life. Since little is known about the effects of rehabilitation and self-management in patients with chronic and treatment resistant anxiety and depressive disorders, this is a first attempt to provide a proof-of-concept study in this under-researched but important field.Trial registrationNetherlands Trial Register: NTR3335, registered 7 March 2012.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders on quality of life, symptoms, and empowerment: results of a randomized controlled trial

Zoun

Koekkoek

Sinnema³

et al. 2019

BMC Psychiatry

View full text Add to dashboard Cite

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“…There is wide interest in encouraging self-management due to its potential to improve patient engagement in care and health outcomes for chronic conditions, 52 including HIV 53 and depression. 9 Promoting self-management may also reduce costs on the health care system. 54 However, supporting patient self-management can be difficult in safety-net settings 55 and in HIV care, 53 especially when patients are living with multiple chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

“…A range of evidence-based treatment options exist for depression, including medications, group therapy, cognitive behavioral therapy, and self-management support. 7–9 Depression treatment is associated with improved adherence to antiretroviral therapy 10 and better health outcomes for depression and HIV, 11,12 yet many PLWH in need of mental health care remain untreated or undertreated for depression. 13 Similar to the HIV care cascade, which outlines the steps from HIV diagnosis to viral load suppression, 14 the “depression treatment cascade” depicts the stages from clinical recognition of depression to treatment initiation and, ultimately, remission of symptoms.…”

Section: Introductionmentioning

confidence: 99%

The collaborative care model for HIV and depression: Patient perspectives and experiences from a safety-net clinic in the United States

et al. 2019

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Objectives: Collaborative care models may improve outcomes for both HIV and depression. The model includes routine screening and re-assessment of depressive symptoms as well as care coordination services delivered by an ancillary provider focused on mental health. We sought to explore patient experiences and attitudes about the services received through the collaborative care model, including measurement-based care using the Patient Health Questionnaire-9. Methods: We conducted 17 qualitative interviews with patients in a collaborative care model implemented at an HIV primary care clinic in a safety-net hospital in the United States. Interviews were analyzed using Framework Analysis. Results: Our findings illustrate the ways in which the collaborative care model for depression may be meaningful to patients in HIV care settings. Participants appreciated the support offered through the collaborative care model. Most participants perceived measurement-based care as useful to their providers, and an additional subset used the Patient Health Questionnaire-9 for their own self-management and awareness of depression. Over time, the collaborative care model appeared to motivate some patients to address depressive symptoms. Conclusion: The collaborative care model may be particularly helpful to patients in the way that it reinforces how depressive symptoms can be measured and managed. Furthermore, routine screening and re-measurement for depressive symptoms using the Patient Health Questionnaire-9 hold promise as an additional self-management tool to complement other clinical and supportive services.

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“…Secondary analysis of data from a randomized controlled trial of a self-management support services intervention for chronic depression was used. 9 The randomized trial showed the intervention improved the total RAS score and reduced depressive symptoms and major depressive episodes. For this study, we examined both factor structure and sensitivity to change of the RAS.…”

Section: Introductionmentioning

confidence: 99%

Factor Structure and Sensitivity to Change of the Recovery Assessment Scale

Ludman

2017

J Behav Health Serv Res

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The focus on recovery, not just symptom reduction, in mental health care brings a need for psychometrically sound measures of recovery. This study examined the factor structure and sensitivity to change of a common measure of mental health recovery, the Recovery Assessment Scale (RAS). We conducted a secondary data analysis from a randomized clinical trial of self-management for depression (n = 302). We tested both bifactor and the previously found five-factor model. Sensitivity to change was examined three ways: (1) between the intervention and control group; (2) across time in the intervention group; and (3) in those whose depression remitted. The previous five-factor model was supported. One subscale, no domination by symptoms, was particularly sensitive to change and showed sensitivity to change whereas the subscale reliance on others did not show change in any of the comparisons. Results suggest that the subscales of the RAS should be examined separately in future studies of recovery.

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Organized Self-Management Support Services for Chronic Depressive Symptoms: A Randomized Controlled Trial

Abstract: These findings support providing regular outreach care management and a self-care group offering a combined behavioral and recovery-oriented approach for people with chronic or recurrent depressive symptoms.

Cited by 22 publications

References 59 publications

Effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders on quality of life, symptoms, and empowerment: results of a randomized controlled trial

Effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders on quality of life, symptoms, and empowerment: results of a randomized controlled trial

The collaborative care model for HIV and depression: Patient perspectives and experiences from a safety-net clinic in the United States

Factor Structure and Sensitivity to Change of the Recovery Assessment Scale

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