Brief reportSelf-help strategies that are helpful for sub-threshold depression: A Delphi consensus study
Introduction
Although having diagnostic categories for depression is useful in a clinical setting, epidemiological evidence suggests that depressive disorders exist on a fluid continuum, rather than as discrete syndromes. Depressive symptoms that fall short of meeting diagnostic criteria (variously termed sub-threshold, sub-clinical, sub-syndromal, mild, or minor depression) are prevalent (Rowe and Rapaport, 2006), cause significant functional disability (Cuijpers et al., 2004), increase the risk of developing major depressive disorder (Cuijpers and Smit, 2004), and have considerable economic costs (Cuijpers et al., 2007).
Although several trials have investigated treatments for sub-threshold depression, they involve intervention by health professionals, and an approach that does not further burden clinical resources is preferable. Self-help methods that can be carried out without the need for professional guidance is an alternative, as they are commonly used, particularly for milder forms of depression (Jorm et al., 2004) and are perceived as helpful by the public (Jorm et al., 2005). However, some self-help methods may be less effective than others or even harmful (e.g. substance use).
Many self-help strategies are not amenable to evaluation by randomised controlled trials, e.g. taking time off work or seeking support from friends. Therefore, other approaches to evaluating evidence are required. One approach is to gather the consensus of consumer and professional experts on which self-help strategies are most likely to be helpful. The expert consensus approach has become standard in the development of practice guidelines for clinicians and may be similarly applied to guide the public in what actions they can take.
Once a set of effective self-help strategies is established, they could be promoted to the public in a similar way to other health promotion campaigns that encourage action to reduce risk of heart disease and cancer (Jorm and Griffiths, 2006).
In this paper we report a Delphi consensus study on self-help strategies for sub-threshold depressive symptoms. The aim was to identify strategies that are likely to be both helpful and feasible, and which could be used in a future health promotional campaign.
Section snippets
Delphi method
The Delphi method (Jones and Hunter, 1995) was chosen to assess expert consensus on helpful and feasible self-help strategies for depressive symptoms. Clinicians and researchers with depression expertise formed one panel, while consumers who had experience of depression and were in an advocacy role formed a second panel.
Panel formation
Experts in depression were recruited from Australia, New Zealand, Canada, the USA, the UK, Ireland, and the Netherlands. The professional experts approached were international
Panel members
Ninety-seven panel members (34 professionals, 63 consumers) participated in Round 1. Overall, 49 (50.5%) were male (70.6% of professionals, 39.7% of consumers). Of the 34 professionals, there were 19 psychiatrists, 5 general medical practitioners, 5 clinical psychologists, 3 occupational therapists, 1 mental health resource worker, and 1 psychiatric nurse. The Round 1 questionnaire response rate was 89.5% for professionals and 92.6% for consumers; nine individuals who agreed to participate in
Discussion
This study aimed to determine through expert consensus which self-help strategies for sub-threshold depressive symptoms are likely to be helpful and feasible to implement, and might therefore be good candidates for promotion to the public. Forty-eight strategies were thought likely to be helpful. Of these, the top fourteen were selected, excluding any that were difficult to implement. Rather than selecting a few strategies that everyone should carry out, we chose to select a larger number of
Role of funding source
Funding was provided by the National Health and Medical Research Council and the Colonial Foundation. These funding sources had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
The authors gratefully acknowledge the time and effort of the panel members, without whom this project would not have been possible. Thanks also to the members of the research team, Laura Hart, Claire Kelly, Anna Kingston, and Betty Kitchener, for their assistance with the questionnaire development.
References (12)
- et al.
Minor depression: risk profiles, functional disability, health care use and risk of developing major depression
J. Affect. Disord.
(2004) - et al.
First aid for depression: a Delphi consensus study with consumers, carers and clinicians
J. Affect. Disord.
(2008) - et al.
Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies
Acta Psychiatr. Scand.
(2004) - et al.
Economic costs of minor depression: a population-based study
Acta Psychiatr. Scand.
(2007) - et al.
Qualitative research: consensus methods for medical and health services research
BMJ
(1995) - et al.
Population promotion of informal self-help strategies for early intervention against depression and anxiety
Psychol. Med.
(2006)
Cited by (70)
Determining stakeholder priorities and core components for school-based identification of mental health difficulties: A Delphi study
2022, Journal of School PsychologyIdentifying risk factors and detection strategies for adolescent depression in diverse global settings: A Delphi consensus study
2021, Journal of Affective DisordersFeeling better at work! Mental health self-management strategies for workers with depressive and anxiety symptoms
2019, Journal of Affective DisordersCitation Excerpt :Several studies have confirmed the effectiveness of self-management interventions to support individuals dealing with various chronic conditions such as asthma, diabetes and arthritis (Barlow et al., 2002; Brady et al., 2013). However, to date, only a handful of studies have looked at self-management strategies for depression and anxiety (Eller et al., 2005; Houle et al., 2013; Morgan and Jorm, 2009; van Grieken et al., 2015). Given their high recurrence rate (Andrews, 2001; Hardeveld et al., 2013; Scholten et al., 2013), self-management strategies, which require the daily adoption of various behaviors to manage an illness, appear to be particularly appropriate in dealing with depression and anxiety.