Janie Houle

Depression self-management support: a systematic review.

OBJECTIVE To systematically review empirical evidence regarding the efficacy of depression self-management support (SMS) interventions for improving depression symptomatology and preventing relapse. METHODS Pubmed and PsycINFO databases were searched for relevant articles on depression SMS interventions. Scanning of references in the articles and relevant reviews and communications with field experts yielded additional articles. Two independent reviewers analyzed the articles for inclusion and data was extracted from the selected articles. RESULTS 13 papers met the inclusion criteria and reported the results of six separate studies, including three pilot studies. The results were mostly positive. A majority of the trials assessing depression severity changes found SMS to be superior to care as usual. SMS interventions were found to improve self-management behaviors and self-efficacy. Mixed results were found concerning relapse rates. Promising results were found on assessments of functional status. Based on the findings, cost-effectiveness remains unclear. CONCLUSION SMS has been mostly examined through pilot studies with insufficient power. The results are promising, but larger randomized controlled trials are needed. PRACTICE IMPLICATIONS SMS interventions can be administered by non-physician professionals and are well accepted by patients, but more research is needed before we can recommend implementing specific depression SMS approaches in primary care.

Inequities in Medical Follow-Up for Depression: A Population- Based Study in Montreal

OBJECTIVES The aim of this study was to measure the quality of medical follow-up of depression in a universal-access health care system and identify its main correlates. METHODS This retrospective cohort study of adult patients who received diagnoses of depression between April 2003 and March 2005 in Montreal used administrative data to measure the quality of medical follow-up within the first three months of diagnosis. Indicators of adequate follow-up care included having at least one outpatient visit to a family physician or a psychiatrist, the first follow-up visit within 30 days of diagnosis, more than half of follow-up visits with the same physician, and at least three follow-up visits. RESULTS During the study period, 41,375 Montrealers aged 18 and older received a new diagnosis of depression. Among those, 90% (N=37,071) had at least one visit with a physician (family practitioner or psychiatrist) within the first three months of diagnosis, 59% (N=24,295) benefited from continuity with their usual provider, 50% (N=20,846) received a prompt follow-up visit, and 48% (N=19,819) had optimal contacts with practitioners. Medical follow-up was less adequate for older patients, male patients, patients living in very deprived neighborhoods, and patients with high morbidity levels. The quality of medical follow-up was better when both a family physician and a psychiatrist were involved. CONCLUSIONS The results suggest that universal access facilitates optimal practitioner contacts during the acute treatment phase of depression. However, despite universal access, the findings revealed that some inequities persist.

Glycaemic control and self-management behaviours in Type 2 diabetes: results from a 1-year longitudinal cohort study.

To better understand the associations between changes in self‐management behaviours and glycaemic control.

Chronic physical comorbidity burden and the quality of depression treatment in primary care: A systematic review

OBJECTIVE We examined whether the treatment and follow-up care for depression in routine primary care differs between adults with higher chronic physical comorbidity burden compared to adults with lower chronic physical comorbidity burden and explored factors leading to divergent results across studies. METHODS We conducted a systematic review of English and French articles using Medline, Embase, PsycINFO, CINAHL and Cochrane Controlled Trials Register from inception to July 2013. Reference list and reverse citation searches were also conducted. Search terms included depression, primary care, general practitioner, chronic disease and comorbidity. Study eligibility required inclusion of relevant quality indicators and data contrasting participants with higher and lower chronic physical comorbidity burden. Study selection and quality appraisal were carried out independently by two review authors. A narrative synthesis of results was performed. RESULTS Our search yielded 5817 unique citations and 46 studies met inclusion criteria. Studies provided data on quality of pharmacotherapy (n=28), psychotherapy (n=4), combined measures of treatment quality (n=14), and follow-up care (n=9). Across studies, evidence that higher chronic physical comorbidity burden was associated with lower depression treatment or follow-up care quality was reported in 13 studies whereas evidence for the opposite relationship was reported in 15 studies. Four studies reported mixed results and 14 studies observed no relationships between comorbidity burden and depression treatment or follow-up care quality. CONCLUSION Review findings suggest that chronic physical comorbidity does not consistently lead to lower quality of depression treatment or follow-up care in primary care.

“Do it All by Myself” A Salutogenic Approach of Masculine Health Practice Among Farming Men Coping With Stress

Farming is often considered one of the most stressful occupations. At the same time, farming men symbolically represent a strong, traditional, or hegemonic form of masculinity based on stoicism, resourcefulness, and resilience to adversity. A contrast is observed between this social representation and their health status, marked by higher levels of stress, social isolation, psychological distress, and suicide than many other subgroups of men. A salutogenic approach was taken in this study to enable the investigation of the social contexts in which farming men positively engage in health-promoting behaviors that may prevent or ameliorate mental health problems. A focus was placed on how farming men cope with stress on their own, and the relationship of this to their popular image of being resourceful and resilient. Thirty-two individual in-depth interviews with farming men and a focus group with five key informants working in rural areas within the Province of Quebec, Canada, were carried out. Self-distraction and cognitive strategies emerged as the most relevant for participants. Notably, taking work breaks conflicted with the discourse of the “relentless worker” that farmers are expected to be. Pathways to positive coping and recovery implied an ambivalence between contemplation of strategies aligned with negative aspects of traditional masculinity norms in North America and strategies aligned with more positive, progressive aspects of these norms based on the importance of family and work life balance. Health promotion and future research should investigate how various positive masculine practices can be aligned with farmers’ health and well-being and that of their family.

Mental health self-management questionnaire: Development and psychometric properties

BACKGROUND Through self-management, people living with depression, anxiety or bipolar disorders can play an active role in their recovery. However, absence of a validated questionnaire limits empirical research on self-management. The study aimed to develop a French instrument, the Mental Health Self-Management Questionnaire (MHSQ), and to investigate its psychometric properties METHODS A pool of 86 items was created based on a qualitative study with 50 people in recovery from depression, anxiety or bipolar disorders. The 64 most pertinent items were identified following ratings from 14 experts. A sample of 149 people in recovery completed these items and criterion-related measures (specific aspects of self-management, clinical and personal recovery, social desirability), and 93 participants also completed MHSQ two weeks later RESULTS Exploratory and confirmatory factor analyses show that MHSQ is composed of three subscales: Clinical (getting help and using resources), Empowerment (building upon strengths and positive self-concept to gain control) and Vitality (active and healthy lifestyle). These subscales had satisfying consistency and test-retest reliability, and were mostly unrelated to social desirability. Correlations with criterion variables support convergent and concurrent validity, especially for Empowerment and Vitality. Comparison of structural models provides evidence of the distinct nature of MHSQ in comparison to the constructs of clinical and personal recovery LIMITATIONS Longitudinal studies with larger samples are needed to explore the validity of MHSQ for predicting recovery over time CONCLUSION MHSQ is a psychometrically-sound instrument, useful for establishing the role of self-management in recovery and monitoring the efficacy of self-management support programs.

Self-Management Strategies in Recovery From Mood and Anxiety Disorders

Mood and anxiety disorders are the most prevalent mental disorders. People with such disorders implement self-management strategies to reduce or prevent their symptoms and to optimize their health and well-being. Even though self-management strategies are known to be essential to recovery, few researchers have examined them. The aim of this study is to explore strategies used by people recovering from depressive, anxiety, and bipolar disorders by asking 50 of them to describe their own strategies. Strategies were classified according to dimensions of recovery: social, existential, functional, physical, and clinical. Within these themes, 60 distinct strategies were found to be used synergistically to promote personal recovery as well as symptom reduction. Findings highlight the diversity of strategies used by people, whether they have depressive, anxiety, or bipolar disorders. This study underscores the importance of supporting self-management in a way that respects individual experience.

Interdisciplinary primary health care research training through TUTOR-PHC: the insiders' view.

Recent policy initiatives in Canada have highlighted the lack of research capacity among most disciplines involved in primary health care, resulting in a majority of clinical and health services research being conducted in secondary and tertiary care centers (Russell et al., 2007). At the same time, interprofessional care is increasingly being seen as a preferred approach to address the complex and wide-ranging clinical problems evident in primary health care. Interdisciplinary research training has therefore been proposed as a way to ensure that research evidence can address the complex interplay between biomedical, psychosocial and organizational dimensions of primary health care. The design of interdisciplinary research training programs requires close attention to the individual components and process factors that explain their long-term effectiveness (or lack of effectiveness) (Campbell et al., 2000). However, little has been reported on the process and influence of such programs. The goals of this paper are threefold: (i) to describe the Transdisciplinary Understanding and Training on Research in Primary Health Care (TUTOR-PHC) program, an interdisciplinary research training program; (ii) to identify content and process elements that were seen as key to its success; and (iii) to outline its influence on participants. As a cohort of trainees and mentor (with backgrounds in health administration, education, epidemiology, family medicine, nursing, physical therapy and psychology), we report on our experience of working together as an ‘‘interdisciplinary research team’’ throughout the program. We hope this paper will contribute to the knowledge base and design of effective interdisciplinary research training programs in the future, by providing participants’ views.

Spousal positive social control and men’s health behaviors and self-efficacy The influence of age and relationship satisfaction

The purpose of this study was to examine the relationship between spousal positive social control (SPSC) and men’s health behaviors. This study also tested the mediating effect of health self-efficacy in this relationship and the moderating effects of age and relationship satisfaction (RS) in the association between SPSC and health behaviors and self-efficacy. A total of 506 unionized male workers answered a questionnaire assessing their level of health self-efficacy, how often they performed various health behaviors, and their perceptions of the frequency with which their spouse used positive social control to influence their health. Results indicated that SPSC was positively associated with health behaviors and that this association was mediated by health self-efficacy. Moderation analysis indicated that, for middle-aged and older men, SPSC was only positively associated with health self-efficacy when RS was high. Also, for older men only, when RS was low, SPSC had a backfiring effect and was negatively associated with health self-efficacy. Finally, results indicated the presence of a moderated mediation with the indirect effect of SPSC on health behaviors through health self-efficacy being moderated by age and relationship satisfaction. By indicating more precisely how, with whom, and under what circumstances SPSC can be beneficial or not, the results from this study have important implications for interventions promoting men’s health.

Implementing a knowledge application program for anxiety and depression in community-based primary mental health care: a multiple case study research protocol.

BackgroundAnxiety and depressive disorders are increasingly recognized as a health care policy priority. Reducing the treatment gap for common mental disorders requires strengthening the quality of primary mental health care. We developed a knowledge application program designed to improve the organization and delivery of care for anxiety and depression in community-based primary mental health care teams in Quebec, Canada. The principal objectives of the study are: to implement and evaluate this evidence-based knowledge application program; to examine the contextual factors associated with the selection of local quality improvement strategies; to explore barriers and facilitators associated with the implementation of local quality improvement plans; and to study the implementation of local quality monitoring strategies.MethodsThe research design is a mixed-methods prospective multiple case study. The main analysis unit (cases) is composed of the six multidisciplinary community-based primary mental health care teams, and each of the cases has identified at least one primary care medical clinic interested in collaborating with the implementation project. The training modules of the program are based on the Chronic Care Model, and the implementation strategies were developed according to the Promoting Action on Research Implementation in Health Services conceptual framework.DiscussionThe implementation of an evidence-based knowledge application program for anxiety and depression in primary care aims to improve the organization and delivery of mental health services. The uptake of evidence to improve the quality of care for common mental disorders in primary care is a complex process that requires careful consideration of the context in which innovations are introduced. The project will provide a close examination of the interplay between evidence, context and facilitation, and contribute to the understanding of factors associated with the process of implementation of interventions in routine care. The implementation of the knowledge application program with a population health perspective is consistent with the priorities set forth in the current mental health care reform in Quebec. Strengthening primary mental health care will lead to a more efficient health care system.