Self-management support system eases chronic depression

[bananas]

Source: UPI

A test program pairing self-management techniques with traditional care helped chronic depression patients cope with their symptoms and live "a life worth living" better than therapy or pharmaceuticals alone, according to a new study by researchers in Seattle.

The program added a behavioral and self-management aspect to standard depression treatment methods, finding more it to be more effective -- at least partially because many depression patients have had experiences seeking treatment that offered no help.

"What makes this program unique is that it combines a traditional mental health model aiming to reduce symptoms with a recovery model focused on achieving life goals despite symptoms," Dr. Evette J. Ludman, a research associate at Group Health Research Institute, said in a press release.

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The additional treatment continued for 18 months, and included depression self-management training, recovery coaching in person and via phone and care coordination. Participants in this group also had access to mental health services in a structured group therapy program based on cognitive behavioral therapy and behavioral activation training.

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Read more: http://www.upi.com/Health_News/2015/08/31/Self-management-support-system-eases-chronic-depression/9241441053950/

[bananas]

1. Press release.

https://www.grouphealthresearch.org/news-and-events/recent-news/news-2015/organized-self-management-support-eases-chronic-depression

August 31, 2015

Organized self-management support eases chronic depression

Randomized controlled trial including peer support helps patients at Group Health and Swedish Medical Center


How to reach people with chronic or recurrent depression? In a randomized trial, they benefited from a self-management support service that included regular outreach care management and a self-care group with a combined behavioral and recovery-oriented approach. Over 18 months, patients improved significantly in all four measured outcomes. Compared to patients in usual care, they had less severe symptoms and less likelihood of having major depression, higher recovery scores, and higher likelihood of being much improved. Psychiatric Services published Organized Self-Management Support Services for Chronic Depressive Symptoms: A Randomized Controlled Trial.

“What makes this program unique is that it combines a traditional mental health model aiming to reduce symptoms with a recovery model focused on achieving life goals despite symptoms,” said study leader Evette J. Ludman, PhD, a senior research associate at Group Health Research Institute.

“When depression persists or recurs, people may start thinking that treatment will never help them to recover,” Dr. Ludman added. “But this intervention really seems effective at improving their lives, and the differences between the groups were continuing to diverge at 18 months.” You can read a blog post that Dr. Ludman wrote about the Organized Self-Management Support Services for Chronic Depressive Symptoms (Stride) trial.


Real-world setting

The randomized controlled trial enrolled more than 300 adult patients at five primary-care clinics Seattle: four at Group Health Cooperatives, and one at Swedish Medical Center. Half of the patients were randomly assigned to keep receiving usual care, including medication, psychotherapy, both, or neither. The other half, in addition to this usual care, received an 18-month intervention that included depression self-management training, recovery coaching, and care coordination. Each participant in the study intervention had regular phone or in-person contacts with an outreach care manager to improve engagement with mental health services and medication therapy. Each patient also participated in a structured group program that a professional therapist and a trained peer specialist co-led. This program was based on cognitive behavioral therapy and behavioral activation skills training. Each peer specialist had had chronic depression and completed a five-day training and certification program from the Depression and Bipolar Support Alliance.

“The care managers, peer specialists, and group program focused on coaching participants to achieve self-care goals and larger life goals for a ‘life worth living,’” Dr. Ludman said. “They emphasized that recovery is possible—while acknowledging that the participants had had disappointing experiences with treatment. The intervention had to remain flexible and geared to individual goals, because people with chronic depression have such varied experiences.”


What’s next?

Most previous attempts to improve the effectiveness of care for depression in the community has focused on people recently diagnosed with depression—not on those with chronic depression. But up to three in 10 people with depression have a chronic course, with depression that keeps recurring or doesn’t completely go away. And persistent depression is linked to poor general health, with other diseases, suicide attempts, and lost work productivity. Persistent depression has also been linked to high use of general medical services.

That’s why the research team plans to study next how the health care costs of the intervention group differ from those of the usual-care group—taking into account the cost of the intervention.

National Institute of Mental Health grant MH065530 supported this trial, which was registered at clinical trials.gov (NCT01139060).

Dr. Ludman’s coauthors were Gregory Simon, MD, MPH; Louis C. Grothaus, MA; Julie Elissa Richards, MPH; and Christine Stewart, PhD; and Ursula Whiteside, PhD.


Group Health Research Institute

Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. The Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems since 1983. Government and private research grants provide its main funding. Follow Group Health research on Twitter, Facebook, Pinterest, LinkedIn, or YouTube.
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[bananas]

2. Researcher's blog post

https://www.grouphealthresearch.org/news-and-events/blog/2015/08/news-release-chronically-depressed-people-find-hope-self-management-support/

Chronically depressed people find hope with self-management support
Aug 31, 2015

Dr. Evette Ludman reflects on the Stride trial that she led with Group Health and Swedish Medical Center patients with chronic depression.

By Evette J. Ludman, PhD, a senior research associate at Group Health Research Institute and the principal investigator of the Stride trial.


When depression won’t go away or keeps coming back, people can lose hope that they might ever feel better. So my colleagues and I were delighted to find significant changes between the usual care and intervention groups in all of the outcome measures that we used ...

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This comment from a participant is a prime example:

“The Stride study marked a real turning point in my life. I got back into counseling, and that has gone very well. And the key that I took away from Stride was that I had to be prepared for the inevitable return of depression; and if I was, I really could mitigate its impact. I’ve identified some vulnerable times and situations and developed some alternative behaviors and ideas… I’ve identified friends and pathways to be with people… and I’ve proactively built plans that help make the life I want with the challenges I face. I’ve got more work to do, but now I have a much clearer sense of what the work is and have a sense that I can do it. Hope is such a blessing.”

—A participant in the Stride trial

As that comment illustrates, the intervention made it clear that recovery from chronic depression is an ongoing process. We didn’t give people the false hope that their depression is likely just to disappear forever. Instead we gave them realistic hope—and stressed how important it is for them to plan for themselves how they can create a life worth living.

The peer specialists, who had experienced depression themselves, served as role models for this kind of self-care and planning. They didn’t say, “I know what’s best for you.” Instead, they said, “You can think of what’s best for you. I can tell you what worked for me. I’ve been there. I continue to walk in your shoes.”

[jtuck004]

3. Ounce of decent weed is anywhere from $75 to $200, and as a self-management

technique for combating chronic depression I suspect there are worse ways, if one lives in a state that exists more in this century.

Maybe with better health care could get something more fancy, but this works.

Not being facetious, since there is now a little research coming out on it.

[beltanefauve]

5. My husband

uses Blue Dream (sativa) daily. It's made a big difference!

[jtuck004]

6. I'm glad he's found something that works for y'all.

There are tens upon tens of millions of people suffering from un-diagnosed depression, imho, self-medicating with lots of things.

Legalizing cannabis will save lives, and provide a better alternative for many.

[davidpdx]

4. I think if you are being closely monitored it could work

But the patient would have to commit to staying on the program and doing everything that is required for it to be effective. Part of the problem is the mental health availability in the US is just awful. Also it is very poorly funded.