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Depressive Symptoms Moderated the Effect of Chronic Illness Self-Management Training on Self-Efficacy

Jerant, Anthony MD*; Kravitz, Richard MD, MSPH; Moore-Hill, Monique MA*; Franks, Peter MD*

doi: 10.1097/MLR.0b013e31815f53a4
Original Article

Background: Identifying moderators of the effects of self-efficacy enhancing interventions could facilitate their refinement and more targeted, cost-effective delivery. Current theories and data concerning the potential moderating effect of depressive symptoms on interventions to enhance patient chronic illness self-management self-efficacy are conflicting.

Objectives: To explore the moderating effect of depressive symptoms on the effect of an intervention to enhance patient self-efficacy for self-managing chronic illness.

Research Design: Regression analyses using baseline and postintervention (6 weeks) data from an ongoing randomized controlled trial.

Subjects: Patients (N = 415) aged ≥40 years recruited from a primary care network in Northern California with arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in ≥1 basic activity, and/or a score of ≥4 on the 10-item Center for Epidemiologic Studies Depression Scale (CES-D).

Measures: Stanford self-efficacy scale, self-reported depression, CES-D, and Medical Outcomes Study Short Form health status questionnaire (SF-36) Mental Component Summary score.

Results: Regression analyses revealed the intervention was effective primarily in those with self-reported depression (interaction effect F = 8.24, P = 0.0003), highest CES-D score category (F = 5.68, P = 0.0037), and lowest (most depressed) Mental Component Summary-36 tercile (F = 4.36, P = 0.0135).

Conclusions: Individuals with more depressive symptoms seem more likely to experience self-efficacy gains from chronic illness self-management training than individuals with less depressive symptoms. Future self-management training studies should stratify subjects within study groups by depressive symptom level to further explore its potential moderating effect.

From the Departments of *Family and Community Medicine and †Internal Medicine, University of California Davis School of Medicine (UCDSOM), Sacramento, California.

Supported in part by Agency for Healthcare Research and Quality grant R01HS013603.

Reprints: Anthony Jerant, MD, Department of Family and Community Medicine, University of California Davis School of Medicine (UCDSOM), 4860 Y Street, Suite 2300, Sacramento, CA 95817. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.