title: A systematically tested intervention for managing reactive depression.
abstract: BACKGROUND
  Patients and family caregivers repeatedly experience reactive depression that leads to medication errors, mismanagement of chronic disease, and poor self-care. These problems place them at high-risk for malnutrition, infection, heart diseases, and psychiatric sequelae.
  
  
  OBJECTIVE
  A secondary data analysis compared findings across a series of studies to evaluate the acceptability, effectiveness, and cost of a therapeutic writing intervention to reduce reactive depression, a common and frequently recurring adverse symptom.
  
  
  METHODS
  Secondary analysis of data from the series of studies was conducted. Data came from patients requiring lifelong, daily central intravenous catheter infusion of home total parenteral nutrition necessitated by nonmalignant bowel disease and their family caregivers who assist with this complex home care. Variables combined across the studies were pre- and postintervention scores from the Center for Epidemiological Studies-Depression Scale (CES-D), the number of weeks patients wrote in their diaries (adherence), and the written content in the diaries. Content analysis was used to analyze written data. The intervention materials and nurses' time spent were averaged across studies to determine costs.
  
  
  RESULTS
  The weighted average baseline CES-D scores across studies for patients (17.94) and caregivers (15.75) showed the presence of depression. After journal writing had been used for an average of 10.4 weeks across studies, the effect sizes of the between (d =.27) and within (d =.65) patient group scores indicated moderate to large improvement in depression. Themes from written diaries showed that missing out on activities, financial worries, strain related to the severe illness, and the complexity of home care were related to depression across the studies.
  
  
  CONCLUSIONS
  The intervention was acceptable to participants, effective for managing reactive depression, and low in cost. The next steps will address testing for the longitudinal effects of the intervention.
authors.affiliation: University of Kansas, School of Nursing, Kansas City 66160-7502, USA. Csmith@kumc.edu
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
authors.forename: Mary Hobbs
authors.initials: MH
authors.lastname: Leenerts
authors.forename: Byron J
authors.initials: BJ
authors.lastname: Gajewski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D002908:Chronic Disease; D003108:Colonic Diseases / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000523:psychology; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology; D012008:Recurrence; D012647:Self-Assessment; D014956:Writing