title: The self-management of longer-term depression: learning from the patient, a qualitative study.
abstract: BACKGROUND
  Depression is a common mental health condition now viewed as chronic or long-term. More than 50 % of people will have at least one further episode of depression after their first, and therefore it requires long-term management. However, little is known about the effectiveness of self-management in depression, in particular from the patients' perspective. This study aimed to understand how people with longer-term depression manage the condition, how services can best support self-management and whether the principles and concepts of the recovery approach would be advantageous.
  
  
  METHODS
  Semi-structured in depth interviews were carried out with 21 participants, recruited from a range of sources using maximum variation sampling. Interpretative Phenomenological Analysis was used by a diverse team comprised of service users, practitioners and academics.
  
  
  RESULTS
  Four super-ordinate themes were found: experience of depression, the self, the wider environment, 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 wellbeing.
  
  
  CONCLUSIONS
  Services in general were not perceived to be useful in specifically facilitating self-management. Increased choice and control were needed and a greater emphasis on an individualised holistic model. Improved information was needed about how to develop strategies and locate resources, especially during the first episode of depression. These concepts echoed those of the recovery approach, which could therefore be seen as valuable in aiding the self-management of depression.
authors.affiliation: Sheffield Hallam University, Centre for Health & Social Care Research, Collegiate Crescent Campus, Sheffield, S10 2BP, UK. e.chambers@shu.ac.uk.
authors.forename: Eleni
authors.initials: E
authors.lastname: Chambers
authors.affiliation: Sheffield Hallam University, Centre for Health & Social Care Research, Collegiate Crescent Campus, Sheffield, S10 2BP, UK. s.p.cook@shu.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cook
authors.affiliation: University of Hertfordshire, Doctorate in Clinical Psychology, Health Research Building, College Lane Campus, Hatfield, AL10 9AB, UK. annathake@googlemail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Thake
authors.affiliation: University of Sheffield, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. alexis.foster@sheffield.ac.uk.
authors.forename: Alexis
authors.initials: A
authors.lastname: Foster
authors.affiliation: , Sheffield, UK. sue@dogrough.plus.com.
authors.forename: Sue
authors.initials: S
authors.lastname: Shaw
authors.affiliation: University of Sheffield, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. r.hutten@sheffield.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hutten
authors.affiliation: University of Sheffield, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. g.d.parry@sheffield.ac.uk.
authors.forename: Glenys
authors.initials: G
authors.lastname: Parry
authors.affiliation: University of Sheffield, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. t.ricketts@sheffield.ac.uk.|Sheffield Health and Social Care NHS Foundation Trust, St George's Community Health Centre, Winter Street, S3 7ND, Sheffield, UK. t.ricketts@sheffield.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Ricketts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D007858:Learning; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D036301:Qualitative Research; D012648:Self Care / Q000379:methods / Q000523:psychology*; D055815:Young Adult