Organized Self-Management Support Services for Chronic Depressive Symptoms: A Randomized Controlled Trial.
OBJECTIVE
This study aimed to determine whether a self-management support service was more effective than treatment as usual in reducing depressive symptoms and major depressive episodes and increasing personal recovery among individuals with chronic or recurrent depressive symptoms.


METHODS
The study was a randomized controlled trial of a self-management support service consisting of depression self-management training, recovery coaching, and care coordination. The 18-month intervention included regular telephone or in-person contacts with a care manager and a structured group program co-led by a professional therapist and a trained peer specialist. Intervention (N=150) and control (N=152) participants ages ≥ 18 with chronic or recurrent depressive symptoms were recruited from five clinics in Seattle, Washington. Outcome measures included the Hopkins Symptom Checklist depression scale, the Recovery Assessment Scale, the Patient-Rated Global Improvement scale, and the percentage of participants with a major depressive episode. Interviewers were masked to treatment condition.


RESULTS
Repeated-measures estimates of the long-term effect of the intervention versus usual care (average of the six-, 12-, and 18-month outcomes adjusted for age, gender, and site) indicated that intervention participants had less severe symptoms (p=.002) and higher recovery scores (p=.03), were less likely to be depressed (odds ratio [OR]=.52, p=.001), and were more likely to be much improved (OR=1.96, p=.001).


CONCLUSIONS
These findings support providing regular outreach care management and a self-care group offering a combined behavioral and recovery-oriented approach for people with chronic or recurrent depressive symptoms.
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: ludman.e@ghc.org ).
Evette J
EJ
Ludman
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: ludman.e@ghc.org ).
Gregory E
GE
Simon
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: ludman.e@ghc.org ).
Louis C
LC
Grothaus
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: ludman.e@ghc.org ).
Julie Elissa
JE
Richards
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: ludman.e@ghc.org ).
Ursula
U
Whiteside
The authors are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: ludman.e@ghc.org ).
Christine
C
Stewart
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D012648:Self Care; D013689:Telephone; D016896:Treatment Outcome; D014861:Washington; D055815:Young Adult
D000928:Antidepressive Agents