Abstract
Background: Patients and family caregivers repeatedly experience reactive depression that leads to medication errors, mismanagement of chronic disease, and poor self-care. These problems place them at high-risk for malnutrition, infection, heart diseases, and psychiatric sequelae.
Objectives: A secondary data analysis compared findings across a series of studies to evaluate the acceptability, effectiveness, and cost of a therapeutic writing intervention to reduce reactive depression, a common and frequently recurring adverse symptom.
Methods: Secondary analysis of data from the series of studies was conducted. Data came from patients requiring lifelong, daily central intravenous catheter infusion of home total parenteral nutrition necessitated by nonmalignant bowel disease and their family caregivers who assist with this complex home care. Variables combined across the studies were pre- and postintervention scores from the Center for Epidemiological Studies-Depression Scale (CES-D), the number of weeks patients wrote in their diaries (adherence), and the written content in the diaries. Content analysis was used to analyze written data. The intervention materials and nurses' time spent were averaged across studies to determine costs.
Results: The weighted average baseline CES-D scores across studies for patients (17.94) and caregivers (15.75) showed the presence of depression. After journal writing had been used for an average of 10.4 weeks across studies, the effect sizes of the between (d = .27) and within (d = .65) patient group scores indicated moderate to large improvement in depression. Themes from written diaries showed that missing out on activities, financial worries, strain related to the severe illness, and the complexity of home care were related to depression across the studies.
Conclusions: The intervention was acceptable to participants, effective for managing reactive depression, and low in cost. The next steps will address testing for the longitudinal effects of the intervention.
Reactive depression is differentiated from major psychiatric depression in that it involves intermittent, recurrent short episodes of low mood (American Psychiatric Association, 1994), as measured by the Center for Epidemiological Studies-Depression Scale (CES-D), a standard screening instrument (Radloff & Rae, 1979). Major depression, in addition to a longer duration, is often associated with internal, neurochemical imbalances; whereas, reactive depression occurs in response to external factors and is a brief disorder. An initial conceptual analysis found other descriptors of reactive depression including cyclic depression, situation depression, depressed mood, and depression of chronic illness. For more than 10,000 patients with brief, depressive episodes presenting as maladjustment, depressed mood, sense of loss, no pleasure in social activities, or impairment in daily function, the findings showed significantly lower physical, social, and function scores than in those without depression (Mulsant, Ganguli, & Seaburg, 1997). Symptoms of reactive depression include inability to concentrate, poor appetite, restless sleep, lack of hope, fearfulness, fatigue, sadness, crying for unknown reasons, and not feeling valued.