title: A secondary analysis of the moderating effects of depression and multimorbidity on the effectiveness of a chronic disease self-management programme.
abstract: OBJECTIVE
  Patients accessing the chronic disease self-management programme (CDSMP) often report multiple long-term conditions (multimorbidity). Although multimorbidity often predicts poor outcomes, CDSMP effectiveness may be enhanced in multimorbidity via synergies between self-management for different conditions. This study assessed whether CDSMP benefits varied by patterns of multimorbidity.
  
  
  METHODS
  The study was based on a secondary analysis of an RCT. Patients with long-term conditions (n=629) were randomised to CDSMP or wait-list and completed baseline and 6 month assessments. We identified four multimorbidity groups: (1) single physical condition; (2) multiple physical conditions; (3) single physical condition plus 'probable depression'; (4) multiple physical conditions plus 'probable depression'.
  
  
  RESULTS
  Multimorbidity group significantly moderated the effect of CDSMP on vitality, health-related quality of life, and mental well-being, with the greatest benefit found for patients with multiple physical conditions plus 'probable depression'.
  
  
  CONCLUSIONS
  The coexistence of depression and multiple physical conditions is associated with increased illness burden, but such patients benefit more from the CDSMP. The mechanisms underlying this effect are unclear, but it does not appear to be through self-management or self-efficacy.
  
  
  CONCLUSIONS
  The presence of multimorbidity in combination with depression may be a useful criteria for referral to the CDSMP.
authors.affiliation: National Institute for Health Research School for Primary Care Research, Health Sciences Research Group, University of Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Harrison
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.forename: Elaine
authors.initials: E
authors.lastname: Harkness
authors.forename: Jose
authors.initials: J
authors.lastname: Valderas
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Mark
authors.initials: M
authors.lastname: Hann
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D012959:Socioeconomic Factors; D006113:United Kingdom