August 31, 2015

Chronically depressed people find hope with self-management support



Dr. Evette Ludman reflects on the Stride trial that she led with Group Health and Swedish Medical Center patients with chronic depression.

By Evette J. Ludman, PhD, a senior research associate at Group Health Research Institute and the principal investigator of the Stride trial.

When depression won’t go away or keeps coming back, people can lose hope that they might ever feel better. So my colleagues and I were delighted to find significant changes between the usual care and intervention groups in all of the outcome measures that we used in Organized Self-Management Support Services for Chronic Depressive Symptoms: A Randomized Controlled Trial. (Psychiatric Services published it, and you can read the news release about the trial.

But even when we get good results from a mental health intervention like this, we have to be honest with ourselves: Sometimes people feel better for reasons that aren’t a direct consequence of the work that we did with them.

On the other hand, the feedback we received from many Stride participants in the intervention group showed that they had gotten better for the reasons that we had planned. They had internalized precisely what their care managers and trained peer specialists had tried to convey to them. This comment from a participant is a prime example:

Hope is such a blessing

“The Stride study marked a real turning point in my life. I got back into counseling, and that has gone very well. And the key that I took away from Stride was that I had to be prepared for the inevitable return of depression; and if I was, I really could mitigate its impact. I’ve identified some vulnerable times and situations and developed some alternative behaviors and ideas… I’ve identified friends and pathways to be with people… and I’ve proactively built plans that help make the life I want with the challenges I face. I’ve got more work to do, but now I have a much clearer sense of what the work is and have a sense that I can do it. Hope is such a blessing.”

—A participant in the Stride trial

Peer specialists helped demonstrate recovery process

As that comment illustrates, the intervention made it clear that recovery from chronic depression is an ongoing process. We didn’t give people the false hope that their depression is likely just to disappear forever. Instead we gave them realistic hope—and stressed how important it is for them to plan for themselves how they can create a life worth living.

The peer specialists, who had experienced depression themselves, served as role models for this kind of self-care and planning. They didn’t say, “I know what’s best for you.” Instead, they said, “You can think of what’s best for you. I can tell you what worked for me. I’ve been there. I continue to walk in your shoes.”