title: Depressive symptoms moderated the effect of chronic illness self-management training on self-efficacy.
abstract: BACKGROUND
  Identifying moderators of the effects of self-efficacy enhancing interventions could facilitate their refinement and more targeted, cost-effective delivery. Current theories and data concerning the potential moderating effect of depressive symptoms on interventions to enhance patient chronic illness self-management self-efficacy are conflicting.
  
  
  OBJECTIVE
  To explore the moderating effect of depressive symptoms on the effect of an intervention to enhance patient self-efficacy for self-managing chronic illness.
  
  
  METHODS
  Regression analyses using baseline and postintervention (6 weeks) data from an ongoing randomized controlled trial.
  
  
  METHODS
  Patients (N = 415) aged >or=40 years recruited from a primary care network in Northern California with arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in >or=1 basic activity, and/or a score of >or=4 on the 10-item Center for Epidemiologic Studies Depression Scale (CES-D).
  
  
  METHODS
  Stanford self-efficacy scale, self-reported depression, CES-D, and Medical Outcomes Study Short Form health status questionnaire (SF-36) Mental Component Summary score.
  
  
  RESULTS
  Regression analyses revealed the intervention was effective primarily in those with self-reported depression (interaction effect F = 8.24, P = 0.0003), highest CES-D score category (F = 5.68, P = 0.0037), and lowest (most depressed) Mental Component Summary-36 tercile (F = 4.36, P = 0.0135).
  
  
  CONCLUSIONS
  Individuals with more depressive symptoms seem more likely to experience self-efficacy gains from chronic illness self-management training than individuals with less depressive symptoms. Future self-management training studies should stratify subjects within study groups by depressive symptom level to further explore its potential moderating effect.
authors.affiliation: Department of Family and Community Medicine, University of California Davis School of Medicine (UCDSOM), 4860 Y Street, Suite 2300, Sacramento, CA 95817, USA. afjerant@ucdavis.edu
authors.forename: Anthony
authors.initials: A
authors.lastname: Jerant
authors.forename: Richard
authors.initials: R
authors.lastname: Kravitz
authors.forename: Monique
authors.initials: M
authors.lastname: Moore-Hill
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D012044:Regression Analysis; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D013689:Telephone; D016896:Treatment Outcome