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Published Online: 17 August 2015

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

Abstract

Objective:

This study aimed to determine whether a self-management support service was more effective than treatment as usual in reducing depressive symptoms and major depressive episodes and increasing personal recovery among individuals with chronic or recurrent depressive symptoms.

Methods:

The study was a randomized controlled trial of a self-management support service consisting of depression self-management training, recovery coaching, and care coordination. The 18-month intervention included regular telephone or in-person contacts with a care manager and a structured group program co-led by a professional therapist and a trained peer specialist. Intervention (N=150) and control (N=152) participants ages ≥18 with chronic or recurrent depressive symptoms were recruited from five clinics in Seattle, Washington. Outcome measures included the Hopkins Symptom Checklist depression scale, the Recovery Assessment Scale, the Patient-Rated Global Improvement scale, and the percentage of participants with a major depressive episode. Interviewers were masked to treatment condition.

Results:

Repeated-measures estimates of the long-term effect of the intervention versus usual care (average of the six-, 12-, and 18-month outcomes adjusted for age, gender, and site) indicated that intervention participants had less severe symptoms (p=.002) and higher recovery scores (p=.03), were less likely to be depressed (odds ratio [OR]=.52, p=.001), and were more likely to be much improved (OR=1.96, p=.001).

Conclusions:

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.

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Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Landscape, by Louis Comfort Tiffany, ca. 1892. Stained glass. Private Collection. Photo credit: Art Resource, New York City.

Psychiatric Services
Pages: 29 - 36
PubMed: 26278222

History

Received: 1 July 2014
Revision received: 18 March 2015
Accepted: 24 April 2015
Published online: 17 August 2015
Published in print: January 01, 2016

Authors

Details

Evette J. Ludman, Ph.D.
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: [email protected]).
Gregory E. Simon, M.D., M.P.H.
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: [email protected]).
Louis C. Grothaus, M.A.
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: [email protected]).
Julie Elissa Richards
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: [email protected]).
Ursula Whiteside, Ph.D.
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: [email protected]).
Christine Stewart, Ph.D.
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: [email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

National Institute of Mental Health10.13039/100000025: R01MH082995
The study was supported by grant MH065530 from the National Institute of Mental Health and was registered at clinical trials.gov (NCT01139060).

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