title: Helpful self-management strategies to cope with enduring depression from the patients' point of view: a concept map study.
abstract: BACKGROUND
  Despite the development of various self-management programmes that attempt to ameliorate symptoms of patients with chronic major depressive disorder (MDD), little is known about what these patients perceive as helpful in their struggle during daily live. The present study aims to explore what patients believe they can do themselves to cope with enduring MDD besides professional treatment, and which self-management strategies patients perceive as being most helpful to cope with their MDD.
  
  
  METHODS
  We used concept mapping, a method specifically designed for the conceptualisation of a specific subject, in this case patients' point of view (n = 25) on helpful self-management strategies in their coping with enduring MDD. A purposive sample of participants was invited at the Academic Medical Center and through requests on several MDD-patient websites in the Netherlands. Participants generated strategies in focus group discussions which were successively clustered on a two-dimensional concept map by hierarchical cluster analysis.
  
  
  RESULTS
  Fifty strategies were perceived as helpful. They were combined into three meta-clusters each comprising two clusters: A focus on the depression (sub clusters: Being aware that my depression needs active coping and Active coping with professional treatment); An active lifestyle (sub clusters: Active self-care, structure and planning and Free time activities) and Participation in everyday social life (sub clusters: Social engagement and Work-related activities).
  
  
  CONCLUSIONS
  MDD patients believe they can use various strategies to cope with enduring MDD in daily life. Although current developments in e-health occur, patients emphasise on face-to-face treatments and long-term relations, being engaged in social and working life, and involving their family, friends, colleagues and clinicians in their disease management. Our findings may help clinicians to improve their knowledge about what patients consider beneficial to cope with enduring MDD and to incorporate these suggested self-management strategies in their treatments.
authors.affiliation: Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. r.a.vangrieken@amc.uva.nl.
authors.forename: Rosa A
authors.initials: RA
authors.lastname: van Grieken
authors.affiliation: Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. anneloeskirkenier@hotmail.com.
authors.forename: Anneloes C E
authors.initials: AC
authors.lastname: Kirkenier
authors.affiliation: Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. m.w.koeter@amc.uva.nl.
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.affiliation: Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. aart.schene@radboudumc.nl.|Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 6, 6500 HB, Nijmegen, The Netherlands. aart.schene@radboudumc.nl.|Donders Institute for Brain, Cognition and Behavior, Radboud University, Geert Grooteplein Noord 21, 6525 EZ, Nijmegen, the Netherlands. aart.schene@radboudumc.nl.
authors.forename: Aart H
authors.initials: AH
authors.lastname: Schene
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D017144:Focus Groups / Q000379:methods; D033062:Friends / Q000523:psychology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D012648:Self Care / Q000379:methods / Q000523:psychology*