Efficacy of Life Adaptation Skills Training for persons with depression
Date Issued
2015
Date
2015
Author(s)
Chen, Yun-Ling
Abstract
Background Depression has become a significant health care problem around the world. The World Health Organization ranked depression as the fourth leading cause of disability and predicted it to be the first leading causes of burden of disease in high-income countries by 2030. Quality of life (QOL) has gained prominence as a patient-reported outcome (PRO) in healthcare services and research for people with mental illness. Quality of Life (QOL) is a generic, multidimensional construct that describes an individual’s subjective perception of his or her overall life satisfaction, physical health, psychological health, social relationships/functioning, and environment. The results of previous studies showed that sense of competence, sense of mastery, environmental resources, satisfaction with social support, level of depression, level of anxiety, use of anti-depressant medication, age, gender, and education level all played important roles in determining QOL for persons with depression. Depression is often chronic and can result in difficulties with work and psychosocial functioning, as well as creating a social burden on the community in which the individual resides. The role of occupational therapy is to promote health and participation through engagement in occupation, which has been associated with a reduction in depressive symptoms and significantly correlated with QOL for persons with mental illness. However, there is limited evidence of the effectiveness of occupation-based QOL intervention programs for persons with depression in Taiwan. Based on previous predictive QOL models, experiences, psychotherapeutic workbooks and manuals and relevant online resources, the researcher has developed a novel and manualized treatment program called “Life Adaptation Skills Training (LAST)” for persons with depression in Taiwan. Prior to research, two pilot studies were conducted which found that the LAST program was a feasible option for people with mental illness who lived in the community and that the program decreased their levels of depression. The purpose of the study was to examine the efficacy of LAST for QOL, symptom reduction, and occupational and environmental improvement for persons with depression, as compared with a control group in a single blind, randomized controlled trial. Methods Sixty-eight subjects with depressive disorder were recruited from psychiatric outpatients clinics in Taipei City and were randomly assigned to either the intervention group (N=33) or control group (N=35). The intervention group participated in 24 group sessions of LAST and was contacted 24 times by phone. The control group received only the 24 phone calls. The primary outcome measure was the World Health Organization Quality of Life-BREF-Taiwan version. The secondary outcome measures included occupational self assessment, mastery scale, social support questionnaire, Beck anxiety inventory, Beck depression inventory-II, and Beck scale for suicide ideation. The mixed-effects linear model was applied to analyze the efficacy of LAST and the partial eta squared (ηp2) was used to examine the within- and between-group effect size. Results The results showed that LAST was effective in reducing the level of anxiety and suicidal ideation with a moderate to large between- and within-group effect size for persons with depression; it also had a maintenance effect of at least three months. The experiment group subjects significantly improved their overall QOL, overall health, physical QOL, and psychological QOL, as well as reduction their levels of anxiety and levels of depression, with larger within-group effect size than those in the control group during the 6-month study period. However, these outcomes did not show significant intervention effect. The LAST group participants enjoyed the intervention sessions and felt that the sessions helped them to manage their daily life routines and learn new ways to cope with stressful problems. The intervention provided them with some therapeutic factors, including universality, instillation of hope, existential factors, catharsis, and development of socializing techniques. Conclusion For persons with depression living in the community, the 24-session occupation-based LAST program, which focuses on lifestyle rearrangement and coping skills enhancement, significantly reduced levels of anxiety and suicidal ideation, with moderate to large between- and within-group effect size and a maintenance effect of at least three months. Moreover, the LAST program was feasible to use with persons suffering from mental illness who lived in the community. In the future, the cost-effectiveness of the short-term LAST program, the efficacy of LAST on other populations, and the positive effects of phone contact could be further examined.
Subjects
depressive disorder
quality of life
occupational therapy program
feasibility
efficacy
SDGs
Type
thesis
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