APNA 30th Annual Conference Session 2013: October 20, 2016 The - - PDF document

APNA 30th Annual Conference Session 2013: October 20, 2016 Hagerty 1

The Impact of a Self-Management Intervention Use on Depression Outcomes

Bonnie M. Hagerty, PhD, RN Melissa A. Bathish, PhD, RN, CPNP School of Nursing, University of Michigan, Ann Arbor, MI

*The speaker has no conflicts of interest to disclose

Learning Objectives

• 1. The learner will be able to identify the impact of self-

management on health outcomes of individuals who suffer from recurrent depression.

• 2. The learner will be able to describe the PIM-D model of self-

management.

• 3. The learner will be able to describe the impact of a self-

management intervention on depression and related health

• utcomes.

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Background and Significance

• Depression is the leading cause of disability in the U.S. and second

leading cause worldwide.

• Depression is a chronic, recurrent illness and is associated with other

chronic illnesses.

• Self-management is a critical strategy for managing chronic illness,

including depression.

• Depression self-management can influence health outcomes.
• By understanding and identifying early symptoms as related to one’s

depression and using an identified repertoire of self-regulation strategies, individuals can learn ways of dealing with their depression.

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Purpose

• To explore the impact of using a self-management intervention

(PIM-D) on depression outcomes.

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Theoretical Framework

• PIM-D was based on two theoretical frameworks; metacognition and

self-regulation.

• Metacognition is knowledge about personal thinking that enables one

to self-reflect and plan, strategize, monitor, and regulate cognitive processes in a systematic way.

• A person’s insight into and control over their mental processes is

essential to self-regulation.

• Self-regulation consists of identifying predetermined elements,

making judgments about their meaning, and using specific strategies to react.

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Development of the Preventive Illness Management of Depression (PIM-D) Intervention

• The Preventive Illness Management of Depression (PIM-D)

Intervention was developed to help prevent or lessen the severity of a recurrent depressive episode through self- regulation by enabling individuals to:

• Identify and monitor prodromal symptoms
• Judge their severity
• Select appropriate coping strategies
• Test the strategies
• Evaluate their success

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The Preventive Illness Management of Depression (PIM-D) Intervention

• PIM-D is based on the premise that preventing depression recurrence

involves behavior of the individual that is influenced by social determinants that include social, personal, health system, and cultural factors.

• Self-management requires an individual to be motivated and able to

implement the activities that influence recurrence of an episode of depression or its severity.

• By understanding and identifying early symptoms as related to their

depression and using an identified repertoire of self-regulation strategies, individuals can learn ways of dealing with their depression. This model and intervention can be used across cultures and countries as an important self-management strategy.

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Preventive Illness Management

• f Depression (PIM-D) Model

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Methods-Sample

• PIM-D was presented to individuals with Recurrent Major Depressive

Disorder.

• A total of 23 subjects participated. Thirteen have completed 6 month data

collection and are included in analyses.

• Inclusion Criteria:
• Diagnosed with Major Depressive Disorder
• Suffered from two or more episodes of depression
• Age 21 or older
• Exclusion Criteria:
• Current substance abuse or addiction problem
• Diagnosed with Bipolar Disorder

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Methods-Procedure

• The intervention was delivered during three 1 ½ hour group sessions

via presentation, group discussion, a manual containing activities designed to teach the model, and voluntary homework assignments.

• Pre-intervention and six month post-intervention questionnaires

assessed demographic factors including age, marital status, income, education, gender and employment information.

• Depression ratings, functioning, quality of life and self-efficacy were

also collected pre-intervention and 6 months post-intervention.

• Telephone interviews were conducted at three months to determine

depression (BDI II) scores, status of daily activities, and use of the intervention.

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Methods-Analysis

• Descriptive and comparative analyses were conducted to identify

relationship patterns between health outcomes and use of the intervention.

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Results

• Demographics:
• Mean age = 43.2 years
• 77% females
• 92% White
• 38.5% had a Bachelor’s degree, 31% had some college credit,

8% had high school diploma or GED

• 62% were single or never married, 23% divorced, 15% married
• 31% employed part-time, 23% out of work or looking for job, 15%

employed but consider themselves underemployed or

• verqualified for job
• 46% earned less than $24,999/year, 31% earned $25,000 to

$49,000/year

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Results

• Results indicate that the PIM-D intervention appeared to be

connected to lower Beck Depression Inventory (BDI) scores.

• 6 months post-intervention, the number of days participants were

unable to complete daily activities also decreased.

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Table 1. Overall Depression Scores

• Overall depression scores decreased 6 months post-

intervention.

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Table 2. Ability of Subjects to Complete Daily Activities

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• Number of days participants were unable to complete

daily activities decreased 6 months post-intervention

aDays per month. bPercentage decrease from pre‐intervention ability to complete daily activities.

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Results

• Individuals who used the intervention sometimes, often, or

always had a greater decrease in BDI scores at 3 and 6 months post-intervention (11.8 point decrease; 7.9 point decrease) than those who never or rarely used it (2.5 point decrease; 4.0 point decrease).

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Table 3. Depression Scores Based on Frequency of Intervention Use

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Results

• At 6 months post-intervention, participants who used PIM-D

more often had improved scores with depression and self- efficacy with little change in quality of life.

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Table 4. Pre-Intervention and 6 Month Post-Intervention Depression Outcomes Based on Frequency of PIM Use

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Table 5. Self-efficacy and Quality of Life Scores

Outcomes Pre‐Intervention Mean (SD) N 6 Months Post‐Intervention Mean (SD) N Self‐efficacy 144 (28.3) 13 153.1 (27.4) 12 Quality of Life 15.1 (3.9) 13 13.2 (3.7) 12

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Implications for Practice and Future Research

• Preliminary results suggest that use of the PIM-D can influence

depression outcomes.

• PIM-D could be a useful strategy for people having difficulty

managing recurrent depression or in which there are no or limited resources to help them with self-management of depression.

• Qualitative analyses on intervention implementation and usage

is currently being completed.

• By November 2016, six month data for entire pilot sample will

be completed (N=23).

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Acknowledgments

• This study was supported by the Karin Allen Fund, University of

Michigan School of Nursing, Ann Arbor, MI.

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