Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/4262751

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Solis, E.C. (2025)

Learning to swim the endless waves: examining self-management and risk factors for (chronic) depression

Doctoral Thesis
According to depression treatment guidelines, psychiatric rehabilitation is recommended for patients with difficult-to-treat persistent depressive disorder (PDD) when previous treatments have been insufficient. Addressing this need, this dissertation evaluated a self-management intervention, the Patient and Partner Education Program for All Chronic Diseases – adapted for PDD (PPEP4All-PDD), designed for patients and their informal caregivers. A secondary aim was to enhance understanding of the long-term trajectory and vulnerability factors associated with depression. Findings indicated no significant differences between PPEP4All-PDD and standard care regarding costs or quality of life, aligning with outcomes from previous rehabilitation studies. When examining depression prognosis, we found that over nine-years, recurrence is the expected course, rather than the exception. Additionally, predictors of relapse, cognitive reactivity (CR) emerged as a moderate independent risk factor...Show moreAccording to depression treatment guidelines, psychiatric rehabilitation is recommended for patients with difficult-to-treat persistent depressive disorder (PDD) when previous treatments have been insufficient. Addressing this need, this dissertation evaluated a self-management intervention, the Patient and Partner Education Program for All Chronic Diseases – adapted for PDD (PPEP4All-PDD), designed for patients and their informal caregivers. A secondary aim was to enhance understanding of the long-term trajectory and vulnerability factors associated with depression. Findings indicated no significant differences between PPEP4All-PDD and standard care regarding costs or quality of life, aligning with outcomes from previous rehabilitation studies. When examining depression prognosis, we found that over nine-years, recurrence is the expected course, rather than the exception. Additionally, predictors of relapse, cognitive reactivity (CR) emerged as a moderate independent risk factor of recurrence for the first episodes. However, a history of previous episodes was identified as the strongest predictor of future recurrence These insights underscore the importance of early relapse prevention in clinical practice to prevent future chronicity and highlight the need for innovative, accessible rehabilitation strategies, such as online adaptations of PPEP4All. Further research is needed to clarify at which point during the treatment process psychiatric is offered to patients.
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Persistent depressive disorder
Treatment-resistant depression
Recurrent depression
Chronic depression
Self-management
Psychiatric rehabilitation
Informal partners
Cognitive vulnerability
Cognitive reactivity
Prognosis
All authors
Solis, E.C.
Supervisor
Hemert, A.M. van
Co-supervisor
Carlier, I.V.E.
Committee
Wee, N.J.A. van der; Does, A.J.W. van der; Rhebergen, D.; Spijker, J.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2025-10-09

Funding

Sponsorship
ZonMw, grant number 843–002-709, Projectleader: I.V.E. Carlier