Social Determinants Related to Depression Outcomes

Purpose:

The World Health Organization has projected that depression will be the second leading cause of disability worldwide by 2020 (Kessler & Bromet, 2013; Murray & Lopez, 1996). Depression is a chronic, recurrent disease associated with behaviors linked to other chronic diseases.  Access to health care impacts recurrence and recovery but in populations and countries where resources are scarce, interventions based on the Preventive Illness Management model that considers social determinants of mental health can help individuals manage depression over time.  By understanding and identifying early symptoms as related to their depression and using an identified repertoire of self-regulation strategies, individuals can learn ways of dealing with their depression. This model and intervention can be used across cultures and countries as an important self-management strategy.

The PIM-D model is based on the premise that preventing recurrence of depression involves behavior of the individual that is influenced by social determinants that include social, personal, health system, and cultural factors.  Self-management requires an individual to be motivated and able to implement the activities that influence recurrence of an episode of depression or its severity. 

The Preventive Illness Management of Depression (PIM-D) Intervention was developed to help prevent or lessen the severity of a depressive episode through self-regulation by enabling individuals to:  identify and monitor prodromal symptoms, judge their severity, select appropriate coping strategies, test the strategies, and evaluate their success. This study’s purposes were to explore social determinants of depression and their relationship to an individual’s motivation and ability to implement self-management strategies and to examine the feasibility and effectiveness of the PIM-D Intervention on depression outcomes.

Methods:

PIM-D was presented to individuals (N=13) with Recurrent Major Depressive Disorder. The intervention was delivered during three 1 ½ hour group sessions via presentation, group discussion, a manual containing activities designed to teach the model, and voluntary homework assignments.   Pre-intervention and six month post-intervention questionnaires assessed depression, functioning, sense of belonging, quality of life, self-efficacy and social support. Telephone interviews were conducted at three months to determine depression (BDI II) scores, status of daily activities, and use of the intervention. 

Results:

Results indicate that the PIM-D intervention lowered Beck Depression Inventory (BDI) scores and decreased the number of days participants were unable to complete daily activities. Key social determinants, including personal, social, educational, and health factors were related to use of the intervention and study outcomes.

Conclusion:

This study suggests that the PIM-D can be a useful intervention when used within the context of interpersonal, social, health system, and cultural factors. We need additional research on how these determinants effect individuals’ utilization of strategies that help them manage their depression over time.  This intervention is easily taught and does not require involvement of a mental health professional. This could be a useful strategy for people in areas in which there are no or limited resources to help them deal with depression.  Depression is a major cause of disability in the world and more strategies that do not require resources or access to care might help decrease adverse health outcomes.  The way in which this PIM model and intervention could be implemented in different cultures requires more exploration.