Chronic Conditions

Individuals with more depressive symptoms are more likely to benefit from training in chronic illness self-management

Individuals suffering from chronic illnesses such as diabetes and asthma must manage their condition through behaviors ranging from control of diet to monitoring certain physiological signs such as blood-sugar levels or breathing capacity. Those suffering from more depressive symptoms are more likely to feel more effective in managing their illness after self-management training than less depressed individuals, according to a new study.

A University of California, Davis School of Medicine team led by Anthony Jerant, M.D., examined the impact of a training program to enhance patient self-efficacy for self-managing chronic illness. They compared self-efficacy reports 6 weeks after the training with feelings of self-efficacy prior to the training among 415 adults 40 years and older from one primary care network. The patients suffered from arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and/or diabetes mellitus, as well as impairment in one or more basic activities and/or a score of 4 or more on the 10-item Center for Epidemiologic Studies Depression Scale (CES-D).

Self-management training focused on three core tasks (medical, role, and emotional management) and six fundamental chronic disease self-management skills (problem solving, decisionmaking, resource utilization, formation of patient-provider partnership, action planning, and self-tailoring). Participants were taught to use behavior change "action plans" and were given extensive opportunities to practice self-management skills and receive feedback on their performance.

The training program led to significant increases in self-efficacy in the one-fourth of individuals with the highest depressive symptom burden (score of 15-28 on the CES-D), and only when delivered via in-home visits (not by telephone). The study was supported in part by the Agency for Healthcare Research and Quality (HS13603).

See "Depressive symptoms moderated the effect of chronic illness self-management training on self-efficacy," by Dr. Jerant, Richard Kravitz, M.D., M.S.P.H., Monique Moore-Hill, M.A., and Peter Franks, M.D., in the May 2008 Medical Care 46(5), pp. 523-531.

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