The Impact of a Self-Management Intervention Use on Depression Outcomes Bonnie M. Hagerty, PhD, RN Melissa A. Bathish, PhD, RN, CPNP School of Nursing, University of Michigan, Ann Arbor, MI *The speaker has no conflicts of interest to disclose Learning Objectives 1. The learner will be able to identify the impact of selfmanagement on health outcomes of individuals who suffer from recurrent depression. 2. The learner will be able to describe the PIM-D model of selfmanagement. 3. The learner will be able to describe the impact of a selfmanagement intervention on depression and related health outcomes. 2 Background and Significance Depression is the leading cause of disability in the U.S. and second leading cause worldwide. Depression is a chronic, recurrent illness and is associated with other chronic illnesses. Self-management is a critical strategy for managing chronic illness, including depression. Depression self-management can influence health outcomes. By understanding and identifying early symptoms as related to one s depression and using an identified repertoire of self-regulation strategies, individuals can learn ways of dealing with their depression. 3 Bonnie M. Hagerty, PhD, RN 1
Purpose To explore the impact of using a self-management intervention (PIM-D) on depression outcomes. 4 Theoretical Framework PIM-D was based on two theoretical frameworks; metacognition and self-regulation. Metacognition is knowledge about personal thinking that enables one to self-reflect and plan, strategize, monitor, and regulate cognitive processes in a systematic way. A person s insight into and control over their mental processes is essential to self-regulation. Self-regulation consists of identifying predetermined elements, making judgments about their meaning, and using specific strategies to react. 5 Development of the Preventive Illness Management of Depression (PIM-D) Intervention The Preventive Illness Management of Depression (PIM-D) Intervention was developed to help prevent or lessen the severity of a recurrent depressive episode through selfregulation by enabling individuals to: Identify and monitor prodromal symptoms Judge their severity Select appropriate coping strategies Test the strategies Evaluate their success 6 Bonnie M. Hagerty, PhD, RN 2
The Preventive Illness Management of Depression (PIM-D) Intervention PIM-D is based on the premise that preventing depression recurrence involves behavior of the individual that is influenced by social determinants that include social, personal, health system, and cultural factors. Self-management requires an individual to be motivated and able to implement the activities that influence recurrence of an episode of depression or its severity. By understanding and identifying early symptoms as related to their depression and using an identified repertoire of self-regulation strategies, individuals can learn ways of dealing with their depression. This model and intervention can be used across cultures and countries as an important self-management strategy. 7 Preventive Illness Management of Depression (PIM-D) Model 8 Methods-Sample PIM-D was presented to individuals with Recurrent Major Depressive Disorder. A total of 23 subjects participated. Thirteen have completed 6 month data collection and are included in analyses. Inclusion Criteria: Diagnosed with Major Depressive Disorder Suffered from two or more episodes of depression Age 21 or older Exclusion Criteria: Current substance abuse or addiction problem Diagnosed with Bipolar Disorder 9 Bonnie M. Hagerty, PhD, RN 3
Methods-Procedure The intervention was delivered during three 1 ½ hour group sessions via presentation, group discussion, a manual containing activities designed to teach the model, and voluntary homework assignments. Pre-intervention and six month post-intervention questionnaires assessed demographic factors including age, marital status, income, education, gender and employment information. Depression ratings, functioning, quality of life and self-efficacy were also collected pre-intervention and 6 months post-intervention. Telephone interviews were conducted at three months to determine depression (BDI II) scores, status of daily activities, and use of the intervention. 10 Methods-Analysis Descriptive and comparative analyses were conducted to identify relationship patterns between health outcomes and use of the intervention. 11 Results Demographics: Mean age = 43.2 years 77% females 92% White 38.5% had a Bachelor s degree, 31% had some college credit, 8% had high school diploma or GED 62% were single or never married, 23% divorced, 15% married 31% employed part-time, 23% out of work or looking for job, 15% employed but consider themselves underemployed or overqualified for job 46% earned less than $24,999/year, 31% earned $25,000 to $49,000/year 12 Bonnie M. Hagerty, PhD, RN 4
Results Results indicate that the PIM-D intervention appeared to be connected to lower Beck Depression Inventory (BDI) scores. 6 months post-intervention, the number of days participants were unable to complete daily activities also decreased. 13 Table 1. Overall Depression Scores Overall depression scores decreased 6 months postintervention. 14 Table 2. Ability of Subjects to Complete Daily Activities Number of days participants were unable to complete daily activities decreased 6 months post-intervention a Days per month. b Percentage decrease from pre intervention ability to complete daily activities. 15 Bonnie M. Hagerty, PhD, RN 5
Results Individuals who used the intervention sometimes, often, or always had a greater decrease in BDI scores at 3 and 6 months post-intervention (11.8 point decrease; 7.9 point decrease) than those who never or rarely used it (2.5 point decrease; 4.0 point decrease). 16 Table 3. Depression Scores Based on Frequency of Intervention Use 17 Results At 6 months post-intervention, participants who used PIM-D more often had improved scores with depression and selfefficacy with little change in quality of life. 18 Bonnie M. Hagerty, PhD, RN 6
Table 4. Pre-Intervention and 6 Month Post-Intervention Depression Outcomes Based on Frequency of PIM Use 19 Table 5. Self-efficacy and Quality of Life Scores Outcomes Pre Intervention Mean (SD) N 6 Months Post Intervention Mean (SD) N Self efficacy 144 (28.3) 13 153.1 (27.4) 12 Quality of Life 15.1 (3.9) 13 13.2 (3.7) 12 20 Implications for Practice and Future Research Preliminary results suggest that use of the PIM-D can influence depression outcomes. PIM-D could be a useful strategy for people having difficulty managing recurrent depression or in which there are no or limited resources to help them with self-management of depression. Qualitative analyses on intervention implementation and usage is currently being completed. By November 2016, six month data for entire pilot sample will be completed (N=23). 21 Bonnie M. Hagerty, PhD, RN 7
Acknowledgments This study was supported by the Karin Allen Fund, University of Michigan School of Nursing, Ann Arbor, MI. 22 Bonnie M. Hagerty, PhD, RN 8