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The effectiveness of a minimal psychological intervention on self-management beliefs and behaviors in depressed chronically ill elderly persons: a randomized trial

Published online by Cambridge University Press:  14 September 2011

Catharina C. M. Jonkers ,
Femke Lamers ,
Hans Bosma ,
Job F. M. Metsemakers  and
Jacques Th. M. van Eijk
Catharina C. M. Jonkers*
Affiliation:
Department of Social Medicine, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands
Femke Lamers
Affiliation:
Department of Social Medicine, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands
Hans Bosma
Affiliation:
Department of Social Medicine, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands
Job F. M. Metsemakers
Affiliation:
Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands
Jacques Th. M. van Eijk
Affiliation:
Department of Social Medicine, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands
*
Correspondence should be addressed to: Catharina Jonkers, The Netherlands Organization for Health Research and Development, PO Box 93245, 2509 AE The Hague, the Netherlands. Phone: +31 70 349 5339; Fax: +31 70 349 5393. Email: [email protected].
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Abstract

Background: Chronically ill patients often develop symptoms of depression. They run the risk of sliding into a downward spiral because of the interaction between depression and chronic illness. A minimal psychological intervention (MPI) has been developed to break through the spiral by applying principles of self-management and cognitive behavioral therapy. This study examines the effects of the MPI on self-efficacy, anxiety, daily functioning and social participation.

Methods: A randomized controlled trial compared the MPI with usual care in 361 primary care patients. Nurses visited patients at home over a period of three months. Patients were aged 60 years and older, had minor depression or mild to moderate major depression and either type 2 diabetes mellitus (DM) or chronic obstructive pulmonary disease (COPD). Outcomes were measured at baseline and at one week, three months, and nine months after the intervention period.

Results: At nine months after treatment, the MPI was associated with less anxiety (mean difference 2.5; 95% CI 0.7–4.2) and better self efficacy skills (mean difference 1.8; 95% CI 3.4–0.2), daily functioning (mean difference 1.7; 95% CI 0.6–2.7), and social participation (mean difference 1.3; 95% CI 0.4–2.2). Effect sizes for these outcomes were small to medium (0.29–0.40). Differences were primarily due to a stabilization of outcomes in the intervention group and deterioration in the control group. No major differences were observed between DM and COPD patients.

Conclusions: The intervention appears to be reasonably effective in improving care for chronically ill elderly people. We recommend further evaluation of the MPI, including emphasis on detection and watchful waiting.

Keywords

depressionagedpsychological treatmentoutcomes
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 2 , February 2012 , pp. 288 - 297
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Arrindel, W. A. and Ettema, J. H. M. (1986). SCL-90: Handleiding bij een multidimensionele psychopathalogie-indicator [SCL-90: Manual for a Multidimensional Indicator for Psychopathology]. Lisse: Swets en Zeitlinger B.V.Google Scholar
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychology Review, 84, 191–215.CrossRefGoogle Scholar
Blazer, D. G. (2002). Self-efficacy and depression in late life: a primary prevention proposal. Aging and Mental Health, 6, 315–324.CrossRefGoogle ScholarPubMed
Bosscher, R. J. and Smit, J. H. (1998). Confirmatory factor analysis of the General Self-Efficacy Scale. Behavior Research and Therapy, 36, 339–343.CrossRefGoogle ScholarPubMed
Brody, B. L., Roch-Levecq, A. C., Kaplan, R. M., Moutier, C. Y. and Brown, S. I. (2006). Age-related macular degeneration: self-management and reduction of depressive symptoms in a randomized, controlled study. Journal of the American Geriatrics Society, 54, 1557–1562.CrossRefGoogle Scholar
Cardol, M., de Haan, R. J., van den Bos, G. A., de Jong, B. A. and de Groot, I. J. (1999). The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA). Clinical Rehabilitation, 13, 411–419.Google Scholar
Chatfield, M. D., Brayne, C. E. and Matthews, F. E. (2005). A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies. Journal of Clinical Epidemiology, 58, 13–19.Google Scholar
Chen, G., Gully, S. M. and Eden, D. (2001). Validation of a new General Self-Efficacy Scale. Organizational Research Methods, 4, 62–68.CrossRefGoogle Scholar
Dahan-Oliel, N., Gelinas, I. and Mazer, B. (2008). Social participation in the elderly: what does the literature tell us? Critical Reviews in Physical and Rehabilitation Medicine, 20, 159–176.CrossRefGoogle Scholar
Demers, L., Robichaud, L., Gelinas, I., Noreau, L. and Desrosiers, J. (2009). Coping strategies and social participation in older adults. Gerontology, 55, 233–239.CrossRefGoogle ScholarPubMed
DiMatteo, M. R., Lepper, H. S. and Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.CrossRefGoogle ScholarPubMed
Djernes, J. K. (2006). Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatrica Scandinavica, 113, 372–387.Google Scholar
Gardette, V., Coley, N., Toulza, O. and Andrieu, S. (2007). Attrition in geriatric research: how important is it and how should it be dealt with? Journal of Nutrition, Health and Aging, 11, 265–271.Google ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.Google Scholar
Hunkeler, E. M. et al. (2006). Long-term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ, 332, 259–263.CrossRefGoogle ScholarPubMed
Jerant, A., Kravitz, R., Moore-Hill, M. and Franks, P. (2008). Depressive symptoms moderated the effect of chronic illness self-management training on self-efficacy. Medical Care, 46, 523–531.Google Scholar
Jonkers, C. C. M., Lamers, F., Bosma, H., Metsemakers, J. F., Kempen, G. I. J. M. and van Eijk, J. T. M. (2007). Process evaluation of a minimal psychological intervention to reduce depression in chronically ill elderly persons. Patient Education and Counseling, 68, 252–257.Google Scholar
Kempen, G. I., Sullivan, M., van Sonderen, E. and Ormel, J. (1999). Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact of depressive symptoms. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 54, P380–386.CrossRefGoogle ScholarPubMed
Lamers, F., Jonkers, C. C., Bosma, H., Diederiks, J. P. and van Eijk, J. T. (2006). Effectiveness and cost-effectiveness of a minimal psychological intervention to reduce non-severe depression in chronically ill elderly patients: the design of a randomised controlled trial [ISRCTN92331982]. BMC Public Health, 6, 161.CrossRefGoogle Scholar
Lamers, F. et al. (2010). A minimal psychological intervention in chronically ill elderly patients with depression: a randomized trial. Psychotherapy and Psychosomatics, 79, 217–226.CrossRefGoogle ScholarPubMed
Lorig, K. R. and Holman, H. (2003). Self-management education: history, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26, 1–7.Google Scholar
Marks, R., Allegrante, J. P. and Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (Part I). Health Promotion Practice, 6, 37–43.CrossRefGoogle ScholarPubMed
Pariser, D. and O'Hanlon, A. (2005). Effects of telephone intervention on arthritis self-efficacy, depression, pain, and fatigue in older adults with arthritis. Journal of Geriatric Physical Therapy, 28, 67–73.CrossRefGoogle ScholarPubMed
Penninx, B. W., Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Deeg, D. J. and Wallace, R. B. (1998). Depressive symptoms and physical decline in community-dwelling older persons. JAMA, 279, 1720–1726.Google Scholar
Piette, J. D., Weinberger, M. and McPhee, S. J. (2000). The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial. Medical Care, 38, 218–230.Google Scholar
Rolland, J. S. (1987). Chronic illness and the life cycle: a conceptual framework. Family Process, 26, 203–221.Google Scholar
Sheehan, D. V. et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59 (Suppl. 20), 22–33.Google Scholar
Spitzer, R. L. et al. (1995). Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA, 274, 1511–1517.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K. and Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA, 282, 1737–1744.Google Scholar
van Eijk, J. T., Diederiks, J. P., Kempen, G. I., Honig, A., van der Meer, K. and Brenninkmeijer, W. J. (2004). Development and feasibility of a nurse administered strategy on depression in community-dwelling patients with a chronic physical disease. Patient Education and Counseling, 54, 87–94.Google Scholar