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

• Published in: International psychogeriatrics 2012-02, Vol.24 (2), p.288-297
• Main Authors: Jonkers, Catharina C. M., Lamers, Femke, Bosma, Hans, Metsemakers, Job F. M., van Eijk, Jacques Th. M.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living - psychology; Adult and adolescent clinical studies; Aged; Biological and medical sciences; Chronic Disease - psychology; Chronic illnesses; Clinical trials; Cognitive Therapy - methods; Depression; Depression - psychology; Depression - therapy; Diabetes Mellitus, Type 2 - psychology; Educational Status; Effectiveness; Female; Geriatrics; Health Knowledge, Attitudes, Practice; Humans; Intervention; Male; Medical sciences; Mental depression; Mood disorders; Older people; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Pulmonary Disease, Chronic Obstructive - psychology; Self Care - psychology; Self Efficacy; Social Participation - psychology; Treatment Outcome
• ISSN: 1041-6102; 1741-203X
• DOI: 10.1017/S1041610211001748

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.