Depressive Symptoms Moderated the Effect of Chronic Illness Self-Management Training on Self-Efficacy

Background:Identifying moderators of the effects of self-efficacy enhancing interventions could facilitate their refinement and more targeted, cost-effective delivery. Current theories and data concerning the potential moderating effect of depressive symptoms on interventions to enhance patient chronic illness self-management self-efficacy are conflicting. Objectives:To explore the moderating effect of depressive symptoms on the effect of an intervention to enhance patient self-efficacy for self-managing chronic illness. Research Design:Regression analyses using baseline and postintervention (6 weeks) data from an ongoing randomized controlled trial. Subjects:Patients (N = 415) aged ≥40 years recruited from a primary care network in Northern California with arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in ≥1 basic activity, and/or a score of ≥4 on the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Measures:Stanford self-efficacy scale, self-reported depression, CES-D, and Medical Outcomes Study Short Form health status questionnaire (SF-36) Mental Component Summary score. Results:Regression analyses revealed the intervention was effective primarily in those with self-reported depression (interaction effect F = 8.24, P = 0.0003), highest CES-D score category (F = 5.68, P = 0.0037), and lowest (most depressed) Mental Component Summary-36 tercile (F = 4.36, P = 0.0135). Conclusions:Individuals with more depressive symptoms seem more likely to experience self-efficacy gains from chronic illness self-management training than individuals with less depressive symptoms. Future self-management training studies should stratify subjects within study groups by depressive symptom level to further explore its potential moderating effect.

[1]  J. Simoni,et al.  A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[2]  A. Dietrich,et al.  Systematic review of multifaceted interventions to improve depression care. , 2007, General hospital psychiatry.

[3]  J D Williamson,et al.  Treatment of minor depression in older adults: A pilot study comparing sertraline and exercise , 2007, Aging & mental health.

[4]  B. Weiss,et al.  Does Literacy Education Improve Symptoms of Depression and Self-efficacy in Individuals with Low Literacy and Depressive Symptoms? A Preliminary Investigation , 2007, The Journal of the American Board of Family Medicine.

[5]  S. Azad,et al.  Impact of a functional restoration program on pain and health-related quality of life in patients with chronic low back pain. , 2006, Pain medicine.

[6]  Andy Haines,et al.  Self management of arthritis in primary care: randomised controlled trial , 2006, BMJ : British Medical Journal.

[7]  Kate Lorig,et al.  Living a healthy life with chronic conditions : self-management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema & others , 2006 .

[8]  R. Letz,et al.  Behavioral, social, and affective factors associated with self-efficacy for self-management among people with epilepsy , 2006, Epilepsy & Behavior.

[9]  S. Stewart,et al.  Cognitions and depressive symptoms among ethnic minority adolescents. , 2006, Cultural diversity & ethnic minority psychology.

[10]  C. Gilliam,et al.  The relationship between caregiving self-efficacy and depressive symptoms in dementia family caregivers , 2006, Aging & mental health.

[11]  S. Olney,et al.  Determinants of self efficacy for physical tasks in people with knee osteoarthritis. , 2006, Arthritis and rheumatism.

[12]  Jürgen Unützer,et al.  Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care , 2006, BMJ : British Medical Journal.

[13]  D. Pariser,et al.  Effects of Telephone Intervention on Arthritis Self‐Efficacy, Depression, Pain, and Fatigue in Older Adults with Arthritis , 2005, Journal of geriatric physical therapy.

[14]  Huong Q. Nguyen,et al.  Dyspnea self-management in patients with chronic obstructive pulmonary disease: moderating effects of depressed mood. , 2005, Psychosomatics.

[15]  J. Turner,et al.  Self-efficacy for managing pain is associated with disability, depression, and pain coping among retirement community residents with chronic pain. , 2005, The journal of pain : official journal of the American Pain Society.

[16]  Anthony F Jerant,et al.  Patients' perceived barriers to active self-management of chronic conditions. , 2005, Patient education and counseling.

[17]  K. Lorig,et al.  Long-Term Randomized Controlled Trials of Tailored-Print and Small-Group Arthritis Self-Management Interventions , 2004, Medical care.

[18]  K. Lorig,et al.  Self-management education: History, definition, outcomes, and mechanisms , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[19]  S. Tsay,et al.  Self-efficacy training for patients with end-stage renal disease. , 2003, Journal of advanced nursing.

[20]  Jennifer E. Anderson,et al.  Using Self-Efficacy and a Transtheoretical Model to Develop a Physical Activity Intervention for Obese Women , 2003, American journal of health promotion : AJHP.

[21]  L. Zimmerman,et al.  Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning. , 2003, Heart & lung : the journal of critical care.

[22]  Stuart I. Brown,et al.  Self-management of age-related macular degeneration and quality of life: a randomized controlled trial. , 2002, Archives of ophthalmology.

[23]  A. Kilbourne,et al.  Clinical importance of HIV and depressive symptoms among veterans with HIV infection , 2002, Journal of General Internal Medicine.

[24]  Alexa Stuifbergen,et al.  Disability, social support, and concern for children: depression in mothers with multiple sclerosis. , 2002, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[25]  Debra A. Mikels,et al.  Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. , 2002, The Journal of rheumatology.

[26]  R. Hays,et al.  Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. , 2001, JAMA.

[27]  A. Stewart,et al.  Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes , 2001, Medical care.

[28]  R. Mermelstein,et al.  Changes in self-efficacy and readiness for smoking cessation among women with high school or less education. , 2001, Journal of health and social behavior.

[29]  W A Hargreaves,et al.  Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. , 2000, Archives of family medicine.

[30]  C. Mazure,et al.  Self-efficacy as a mediator between stressful life events and depressive symptoms , 2000, British Journal of Psychiatry.

[31]  J. Piette,et al.  The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial. , 2000, Medical care.

[32]  D. Cervone,et al.  Thinking about Self-Efficacy , 2000, Behavior modification.

[33]  M. Irwin,et al.  Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D) , 1999, Archives of internal medicine.

[34]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[35]  M E Robinson,et al.  Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. , 1997, The Clinical journal of pain.

[36]  K. Lorig.  Outcome measures for health education and other health care interventions , 1996 .

[37]  J. Ware,et al.  Usefulness of the SF-36 Health Survey in Measuring Health Outcomes in the Depressed Elderly , 1996, Journal of geriatric psychiatry and neurology.

[38]  W H Rogers,et al.  Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. , 1995, Medical care.

[39]  G. Bower,et al.  Praise or blame? Affective influences on attributions for achievement. , 1990, Journal of personality and social psychology.

[40]  B. Major,et al.  Perceived social support, self-efficacy, and adjustment to abortion. , 1990, Journal of personality and social psychology.

[41]  P. Salovey,et al.  Influence of mood on health-relevant cognitions. , 1989, Journal of personality and social psychology.

[42]  Michael W. Arthur,et al.  A reexamination of the effectiveness of self-care education for persons with arthritis. , 1989, Arthritis and rheumatism.

[43]  C. Cutrona,et al.  Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression. , 1986, Child development.

[44]  David J. Kavanagh,et al.  Mood and self-efficacy: Impact of joy and sadness on perceived capabilities , 1985, Cognitive Therapy and Research.

[45]  J. E. Maddux,et al.  Self-Efficacy Expectancy and Depression: An Investigation of Causal Relationships. , 1985 .

[46]  Vimla L. Patel,et al.  Web-based tailoring and its effect on self-efficacy: results from the MI-HEART randomized controlled trial , 2002, AMIA.

[47]  D. Clair,et al.  Brave New Brain: Conquering Mental Illness in the Era of the Genome , 2002, Heredity.

[48]  A. Stewart,et al.  Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. , 1999, Medical care.

[49]  J. Ware,et al.  What information do consumers want and how will they use it? , 1995, Medical care.

[50]  C. Holahan,et al.  Self-efficacy, social support, and depression in aging: a longitudinal analysis. , 1987, Journal of gerontology.

[51]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[52]  G. Bower.  Mood and memory. , 1981, The American psychologist.

[53]  H. Holman,et al.  Measurement of patient outcome in arthritis. , 1980, Arthritis and rheumatism.