DEVELOPMENT AND THE EFFECT OF SELF-MANAGEMENT WITH MINDFULNESS-BASED COGNITIVE THERAPY PROGRAM FOR PREVENTING RELAPSE AMONG PEOPLE WITH MAJOR DEPRESSIVE DISORDER

Abstract

               Objective: The aims of this study were to develop and examine the effect of self-management with a mindfulness-based cognitive therapy program for preventing relapse of major depressive disorder, reducing depressive symptoms and ruminative thought, and increasing mindfulness level. It was also to follow up and evaluate the overall results after the service system implementation in the health service of Prasrimahabhodi Psychiatric Hospital.

               Methods: This study was a research and development design during the fiscal year 2020-2022. The 9 phases were: 1) the situation analysis of nursing services in preventing relapse of major depressive disorder, 2) developing an initial prototype of the program, 3) testing the content validity index, 4) testing preliminary in the initial program in five depressed patients, 5) revising the draft program, 6) testing efficacy of the program using a quasi-experimental control group design in 40 depressed patients. They were divided into experimental and control groups. Instruments were the program, depressive symptoms assessment(9Q), Ruminative Response Scale, and Mindfulness Assessment Scale. The outcomes were evaluated at baseline, post-intervention, and follow-up three months after the intervention. Data were analyzed using frequency, percent, Chi-square, and Mann-Whitney U test. Then, the following phases were: 7) revising the final program, 8) developing of curriculum for training and implementation into the health service system of the hospital, and 9) evaluating the effectiveness of this program and continuous development respectively.

               Results: The new program consists of 6 sessions. It takes 60-90 minutes per session and continuously runs 2-3 times per week. The findings of phase six reported that the experimental group significantly reduced the depression score after post-intervention and follow-up three months after the intervention from the control group (p < .05). The experimental group also significantly decreased ruminative thought scores after post-intervention and follow-up three months after the intervention from the control group (p < .05). There were no differences in mindfulness scores between the experimental and control groups. Depressed patients in the experimental group did not have readmission in 3 and 6 months. Still, the control group reported readmission into the hospital accounted for four patients (20%), which was found different significantly (p < .001). One hundred thirty-four depressed patients received the program after implementation into the health service system of the hospital in the fiscal year 2022. However, only two patients, or only 1.49%, reported readmission into the hospital after six months because they had family and economic issues and medication noncompliance.

               Conclusion: The program in self-management with mindfulness-based cognitive therapy could prevent readmission into the hospital in 6 months. It could also help reduce depressive symptoms and ruminative thoughts in depressed patients.