Self-Management for Patients Suffering from Depression

Self-management for chronic or long-term conditions such as pain, diabetes, asthma, or arthritis is now a common part of long-term care. The same is not true for depression. At least, not yet. As clinicians learn more about depression, it has ceased to be viewed alongside other acute conditions and is now often thought of as chronic or long-term. Research shows that more than half of all people will have at least one further depressive episode after their first.

A research article in BMC Psychiatry aimed to understand how people with longer-term depression manage their condition and how medical professionals can support that self-management.

Participants responded to an advertisement and went through initial diagnostic interviews by experienced clinicians, including a clinical psychologist and a psychiatrist. Patients under 18 or suffering from dementia were excluded. The study involved semi-structured in depth interviews with 21 participants.

From the interviews, the researchers noted four key “super-ordinate” themes: experience of depression; the self; the wider environment; and self-management strategies. Within these, several prominent sub-themes emerged of importance to the participants. These included how aspects of themselves such as hope, confidence, and motivation could be powerful agents; and how engaging in a wide range of chosen activities could contribute to their emotional, mental, physical, social, spiritual and creative well-being.

The episodic or cyclical nature of depression was a key theme, with some participants experiencing periods in their life when they had no depressive symptoms and others continually experiencing symptoms but with the severity of the depression varying.These fluctuations were important in participants’ use of self-management strategies.

The study is very detailed on all four themes, but just to point out a few of the observations noted:

• Several participants, unsure if depression would ever go away, found that rather than hoping it would go away, they needed to develop ways of managing it.
• Some people with cycles of depression didn’t feel the need to use self-management between episodes, while others with continuous depression used strategies on an ongoing basis.
• Even for participants reporting a loss of hope and purpose in life when experiencing depression, they discussed how the company of other people and engaging in activities gave them hope and meaning.
• Finding a positive self-identity was an important aspect of coping with depression for some. This involved self-acceptance and self-compassion in order to combat the self-criticism, self-blame and negative comparisons to others.
• Although services were mentioned, the majority had seemingly little direct impact on the self-management abilities of participants, with most people citing other relationships and activities as being more influential, for example:
• Many of the participants became discouraged by the more structured professional care they had experienced, despite a wide range of services having been used, including primary care, secondary mental health services and different services in the voluntary and private sectors, including complementary therapies.
• Participants reported a lack of information or education in a number of areas, both for themselves and other people, including their support groups and the general public.
• Several participants referred to choice with regard to services. Some felt there was a lack of choice between receiving medication and using other services and described a tendency for medication to be prescribed too readily.

The research “indicates the need for a much stronger person-centered approach to services in which the individual’s perception of their goals concerning living with depression are listened to and acted on accordingly, as has been suggested by other patient-focused research,” the study authors note. “A partnership approach is required, that maximizes the patient’s involvement and fosters an atmosphere of hope and motivation. This would include learning about the patient perspective as well as actively informing others about depression to counteract stigma and prejudice.”