The Effects of Self-Management Interventions on Depressive Symptoms In Adults With Chronic Physical Disease(S) Experiencing Depressive Symptomatology: A Systematic Review And Meta-Analysis

Abstract

\n Background: Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management (SM), are part of recommended treatment; however, no systematic review has evaluated the effects of depression SM interventions for this population. Objectives: The primary objective was to examine the effect of SM interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). Methods: Studies comparing depression SM interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary ‘snowball’ search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. Results: Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6 months (T1), the pooled mean effect size was -0.47 [95% CI -0.73, -0.21] as compared to control groups for the primary outcome of depression and -0.53 [95% CI -0.91, -0.15] at ≥ 6-months (T2). Results were also significant for anxiety (T1 and T2) and glycemic control (T2). SM skills of decision-making and taking action were significant moderators of depression at T1. Conclusion: SM interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future SM interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components. Prospero registration: CRD42019132215