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

APNA 30th Annual Conference Session 2013: October 20, 2016 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 outcomes. 2 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. 3 Hagerty 1

APNA 30th Annual Conference Session 2013: October 20, 2016 Purpose • To explore the impact of using a self-management intervention (PIM-D) on depression outcomes. 4 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. 5 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 6 Hagerty 2

APNA 30th Annual Conference Session 2013: October 20, 2016 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. 7 Preventive Illness Management of Depression (PIM-D) Model 8 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 9 Hagerty 3

APNA 30th Annual Conference Session 2013: October 20, 2016 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. 10 Methods-Analysis  Descriptive and comparative analyses were conducted to identify relationship patterns between health outcomes and use of the intervention. 11 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 overqualified for job • 46% earned less than $24,999/year, 31% earned $25,000 to $49,000/year 12 Hagerty 4

APNA 30th Annual Conference Session 2013: October 20, 2016 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. 13 Table 1. Overall Depression Scores  Overall depression scores decreased 6 months post- intervention. 14 Table 2. Ability of Subjects to Complete Daily Activities • Number of days participants were unable to complete daily activities decreased 6 months post-intervention a Days per month. b Percentage decrease from pre ‐ intervention ability to complete daily activities. 15 Hagerty 5

APNA 30th Annual Conference Session 2013: October 20, 2016 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). 16 Table 3 . Depression Scores Based on Frequency of Intervention Use 17 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. 18 Hagerty 6

APNA 30th Annual Conference Session 2013: October 20, 2016 Table 4. Pre-Intervention and 6 Month Post-Intervention Depression Outcomes Based on Frequency of PIM Use 19 Table 5. Self-efficacy and Quality of Life Scores Outcomes Pre ‐ Intervention N 6 Months Post ‐ Intervention N Mean (SD) Mean (SD) Self ‐ efficacy 144 (28.3) 13 153.1 (27.4) 12 Quality of Life 15.1 (3.9) 13 13.2 (3.7) 12 20 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). 21 Hagerty 7

APNA 30th Annual Conference Session 2013: October 20, 2016 Acknowledgments  This study was supported by the Karin Allen Fund, University of Michigan School of Nursing, Ann Arbor, MI. 22 Hagerty 8