Patients' perspective on self-management in the recovery from depression.

BACKGROUND: Self-management appears to be a promising approach in the case of depression, which helps to stimulate patients' autonomy. However, a good and systematic description of the concept self-management from the patients' perspective, to our knowledge, has not yet been performed. OBJECTIVE: To determine: (i) what strategies patients think they can use themselves to recover from depression, (ii) which main themes of self-management strategies can be detected, and (iii) which of these strategies patients perceive as being most helpful. METHODS: We used concept mapping to explore the experiences of patients who recently recovered from a depressive episode. Patients generated self-management strategies in focus group discussions. The strategies were clustered on a two-dimensional concept map by a hierarchical cluster analysis. RESULTS: Patients generated 50 strategies that formed eight clusters: (i) proactive attitude towards depression and treatment, (ii) daily life strategies and rules, (iii) explanation of disease to others, (iv) remaining socially engaged, (v) engaging in activities, (vi) structured attention to oneself, (vii) contact with fellow sufferers, and (viii) other. Behavioural and cognitive strategies and a proactive attitude towards treatment were considered as the most helpful. DISCUSSION AND CONCLUSION: From the patients' perspective, there is a wide range of self-management strategies that they can use - and perceive as helpful- to contribute to their own recovery. Professionals could encourage patients to take an active role in achieving recovery. Further research could open new roads to improve patients' active contributions to current treatments for depression.

Helpful self-management strategies to cope with enduring depression from the patients' point of view: a concept map study.

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.

Patients׳ perspectives on how treatment can impede their recovery from depression.

BACKGROUND: More than 50% of all major depressive disorder (MDD) patients experience insufficient improvement from the available treatment options. There is emerging evidence that patients׳ beliefs and experiences about MDD treatment influence treatment outcomes. The aim was to explore patients׳ perspectives on impeding characteristics of professional treatment for the recovery of MDD. METHODS: In-depth interviews in a purposive sample with 27 recovered MDD patients who had received professional treatment. Data were qualitatively analyzed using constant comparison. RESULTS: Participants׳ accounts yielded four major impeding themes: lack of clarity and consensus about the nature of the participants׳ MDD and the content of their treatment; precarious relationship with the clinician; unavailability of mental health care; and insufficient involvement of significant others. LIMITATIONS: The external generalizability may be limited due to missed other subgroups within depression. CONCLUSIONS: This study identified a comprehensive overview of impeding characteristics in MDD treatment from patients׳ perspectives. This may help clinicians to understand how patients experience MDD treatment, and to incorporate patients׳ perspectives about treatment into their joint decision-making. This can lead towards increased treatment adherence, motivation and finally success.

[Patients' perspective on self-management during recovery from depression]. / Het patiëntenperspectief op zelfmanagement in het herstel van depressie.

OBJECTIVE: To investigate what patients themselves think they can contribute to recovery from depression, and what they find to be effective. The patients' perspective is necessary to improve treatment for depression. DESIGN: Qualitative, hypothesis-generating study. METHOD: The experiences and opinions of 20 patients who had recently recovered from a depressive episode were investigated using the 'concept mapping' method. In the first stage, patients generated statements during group discussions around the question: 'What can people themselves do to recover from depression?' In the second stage, patients individually graded the statements by relevance and grouped them by common characteristics. In the third stage, the statements were analysed and positioned in a concept map. RESULTS: In the first stage, the patients generated 50 statements which could be grouped into the following 8 clusters: active attitude towards depression and the assistance offered, regimen, explanation of the disease to acquaintances, social contacts, undertaking activities, structured attention for yourself, contact with fellow sufferers, and others. The common factor in statements that patients found the most important was that the focus for recovery should be on oneself. CONCLUSION: From the patients' perspective several methods were mentioned by which patients can contribute to their own recovery from depression. Practitioners could use these in their contact with the patient during treatment. This study also provides the basis for developing a self-management module for recovery from depression.