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

Abstract

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 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.