DIRECT-sc: Self-care intervention for depression among adults with chronic physical conditions

Purpose

Intervention for middle-aged or older adults with chronic physical conditions and co-morbid depressive symptoms in a primary care setting. The intervention includes: 1) a toolkit comprising tools in various formats (written, audio-visual) to suit different learning styles (e.g. a widely available workbook, a mood monitoring tool, and complementary tools on life-style factors); 2) coaching by a trained lay self-care coach in a series of short telephone calls. (Note that self-care coaches have a more limited role than health coaches. They receive minimal training and offer only guidance and encouragement in the use of the toolkit. Future iterations of the intervention refer to this support as guidance.)

Evidence

The initial phase of this research assessed the feasibility and acceptability of the intervention in an uncontrolled trial. Subsequently, a randomized controlled trial (RCT) was conducted to compare outcomes of the coached intervention with a self-guided version of the toolkit. The results revealed that coaching significantly reduced depressive symptoms at 3 months but not 6 months. A secondary analysis of these results found that coaching significantly improved outcomes at 6 months among patients who were not receiving outside psychological counseling. Among patients receiving counseling, the coaching did not improve outcomes. This finding led us to recommend that, in future, patients receiving counseling should not also receive lay coaching. As such, the intervention is suitable as a first step in a stepped care program for depression.

Relevant publications:

McCusker J, Cole MG, Yaffe M, Strumpf E, Sewitch M, Sussman T, Ciampi A, Lavoie K, Platt RW, Belzile E. A randomized trial of a depression self-care toolkit with or without lay telephone coaching for primary care patients with chronic physical conditions. General Hospital Psychiatry. 37 (3): 257-265, 2015. [Corrigendum: General Hospital Psychiatry. 40:75-83, 2016]
McCusker J, Cole M, Yaffe M, Sussman T, Lavoie KL, Strumpf E, Sewitch M, Sahin D, de Raad M. A feasibility study of a telephone-supported self-care intervention for depression among adults with a co-morbid chronic physical illness in primary care. Mental Health in Family Medicine, 9 (4): 257-273, 2012
McCusker J, Cole MG, Yaffe M, Strumpf E, Sewitch M, Sussman T, Ciampi A, Lavoie K, Belzile E. Adherence to a depression self-care intervention among primary care patients with chronic physical conditions: a randomized trial. Health Education Journal. 75(7): 767-779, 2016
McCusker J, Lambert S, Cole M, Ciampi A, Freeman E, Belzile E. Activation and self-efficacy in a randomized trial of a depression self-care intervention among primary care patients with chronic physical conditions. Health Education and Behaviour. 43(6):716-725, 2016
McCusker J, Cole MG, 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. 62(1):67-72, 2017
McCusker J, Yaffe M, Sussman T, Cole M, Sewitch M, Strumpf E, Freeman E, Lambert S, de Raad M. La gestion de la dépression chez les personnes atteintes de maladies physiques chroniques et leurs aidants naturels : résultats d'un programme de recherche au Québec. Santé mentale au Québec. XLII(1) :273-288, 2017
McCusker J,Haggerty J, Belzile E, Bourahaoui F, De Raad M, Beaulieu C, Yaffe M, Ciampi A. Development and validation of subscales to assess perceived support for self-management of mood or emotional problems; results from a randomized trial. Patient Education and Counseling. 100(12): 2013-2019, 2017