People with chronic disease learn to manage symptoms of depression

Symptoms of depression – like feeling sad and loss of interest in usual activities – are common among people with chronic diseases like diabetes and arthritis. These feelings can interfere with enjoyment of life and can reduce motivation to take care of the disease, leading to a downward spiral of worsening physical health and mood. As the number of individuals with chronic disease increases and health care resources are stretched, finding a solution to the depression problem has become urgent.

Fig. 1. Selected page from the Toolkit: the mood monitoring tool.

Self-care programs for depression, based on psychological therapies, involve developing skills for setting goals, planning activities, solving problems and challenging depressive thinking habits.  These skills can be acquired through the use of workbooks, notebooks for self-monitoring of mood, and other tools. A team based at St Mary’s Research Centre, Montreal, developed and tested a depression self-care program for adults with chronic disease. The approach involves using a Toolkit (a set of workbooks, CDs and DVDs) which includes exercises that people can do on their own to learn and practice the skills needed to engage in depression self-care. Using a randomized trial, the most rigorous research study design, the researchers compared outcomes in patients who used the toolkit on their own with those who received telephone coaching. Coaches, without formal psychological training, guided and encouraged patients in the use of the materials, offering up to 15 short telephone sessions over 6 months.

Fig. 2. Average severity of depressive symptoms (PHQ-9) by study group for 128 participants not receiving other forms of psychotherapy (from McCusker J, Cole M, Lambert S, Yaffe M, Ciampi A, Belzile E. Baseline psychological treatment reduces the effect of coaching in a randomized trial of a depression self-care intervention Canadian Journal of Psychiatry. 2016 May 5. pii: 0706743716648299.)

The results of this randomized trial showed that the severity of symptoms of depression improved significantly in both coached and uncoached patients over the 6-month follow-up timeframe. Among patients who were not receiving other forms of psychotherapy, the group receiving coaching improved more than the uncoached group. These results indicate that self-care programs for depression are a potentially useful and cost-effective additional treatment option.

Jane McCusker
Department of Epidemiology, Biostatistics and Occupational Health,
McGill University, Montreal, Quebec, Canada
St Mary’s Research Centre, Montreal, Quebec, Canada



A randomized trial of a depression self-care toolkit with or without lay telephone coaching for primary care patients with chronic physical conditions.
McCusker J, Cole MG, Yaffe M, Strumpf E, Sewitch M, Sussman T, Ciampi A, Lavoie K, Platt RW, Belzile E
Gen Hosp Psychiatry. 2016 May-Jun


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