Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial

Psychol Med. 2003 Aug;33(6):1061-70. doi: 10.1017/s003329170300816x.


Background: A randomized trial of a primary care-based intervention to prevent depression relapse resulted in improved adherence to long-term antidepressant medication and depression outcomes. We evaluated the effects of this intervention on behavioural processes and identified process predictors of improved depressive symptoms.

Method: Patients at high risk for depression recurrence or relapse following successful acute phase treatment (N=386) were randomly assigned to receive a low intensity 12-month intervention or continued usual care. The intervention combined education about depression, shared decision-making regarding use of maintenance pharmacotherapy and cognitive-behavioural strategies to promote self-management. Baseline, 3, 6, 9 and 12-month interviews assessed patients' self-care practices, self-efficacy for managing depression and depressive symptoms.

Results: Intervention patients had significantly greater self-efficacy for managing depression (P<0.01) and were more likely to keep track of depressive symptoms (P<0.0001), monitor early warning signs (P<0.0001), and plan for coping with high risk situations (P<0.0001) at all time points compared to usual care control patients. Self-efficacy for managing depression (P<0.0001), keeping track of depressive symptoms (P=0.05), monitoring for early warning signs (P=0.01), engaging in pleasant activities (P<0.0001) and engaging in social activities (P<0.0001) positively predicted improvements in depression symptom scores.

Conclusions: A brief intervention designed to target cognitive-behavioural factors and promote adherence to pharmacotherapy in order to prevent depression relapse was highly successful in changing several behaviours related to controlling depression. Improvements in self-efficacy and several self-management behaviours that were targets of the intervention were significantly related to improvements in depression outcome.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antidepressive Agents / therapeutic use*
  • Cognitive Behavioral Therapy / methods*
  • Depression / diagnosis
  • Depression / prevention & control*
  • Depression / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data
  • Primary Health Care*
  • Risk Factors
  • Secondary Prevention
  • Self Efficacy
  • Severity of Illness Index
  • Social Behavior*
  • Treatment Outcome


  • Antidepressive Agents