Research projects

Motivational interviewing-based health coaching as an early intervention for the prevention of depression in Type II diabetes and cardiovascular disease in an Australian regional and rural population

Principal researchers

Dr Mirella Di Benedetto1
Dr Helen Aucote2
Dr Helen Lindner3

Institution

1 School of Health Sciences, RMIT University
2 Faculty of Arts and Science, Australian Catholic University
3 Australian Psychological Society

Funding

$134,817

Award type

beyondblue Victorian Centre of Excellence

Project completion year

2010

Project brief

Seventy-five percent of Australians have at least one chronic illness: approximately 50 per cent of these will experience depression (AIHW, 2006). Chronic illness significantly increases the risk of depression and, conversely, depression increases the risk for chronic illness (AIHW, 2006). Chronic illnesses, such as diabetes, accompanied by depression are associated with worse prognosis (Katon et al, 2005). Type II diabetes (T2D) and cardiovascular disease (CVD) are largely a result of lifestyle behaviours such as poor diet, inactivity and smoking and there is compelling evidence that these behaviours, particularly inactivity, contribute to depression in these populations (AIHW, 2006; Katon et al, 2005).

More than 50 per cent of Australian adults currently have a sedentary lifestyle (Cerin et al., 2005and the statistics tend to be worse in regional and rural Australia (AIHW, 2006). As there is evidence  (AIHW, 2006; Katon et al, 2005) of the interrelationship between lifestyle factors, chronic illness and depression, it is possible that improvements in chronic illness management by adopting health promoting behaviours will reduce the risk of depression in these populations (Katon et al, 2005). However, successful management of chronic illnesses such as T2D and CVD involves individual behaviour change and self-management (DHS, 2006; Lindner et al., 2003). Therefore, evidence-based behaviour change techniques are essential in adopting healthy behaviours to self-manage T2D and CVD. Generically, health coaching (HC) is a collection of evidence-based behavioural change techniques used in disease management that can address multiple behaviours, health risks, and the self-management of illness (Butterworth et al., 2006) and have been demonstrated to be cost effective.

Aims and hypotheses

  1. To examine the effect of a phone based Motivational Interviewing Health Coaching (MIHC) intervention on mental and physical health status outcomes and cost savings. It is hypothesised that when compared to an active control group, the treatment group would score lower in depression, and display greater improvements in health outcomes (health status, blood pressure [BP], weight, healthy lifestyle behaviours) and would have reduced healthcare costs. \
  2. To examine the effect of MIHC intervention on the variables related to depression. It was hypothesised that when compared to the active control group, the treatment groups would score higher in coping, resilience and perceived controllability, and lower in trait anxiety.
  3. To examine the relationship between the psychological factors (depression, trait anxiety, coping, resilience, and perceived controllability) and health outcomes (health status, BP, weight).
  4. Strengthen the collaborative pathways to mental and physical health care between psychologists, psychiatrists, primary care services, and specialist mental health services by eliciting referrals from these sources to the intervention.

Key findings

One hundred and forty-eight participants whose mean age was 59.39 years (10.65) were recruited for this study. Seventy-six were randomly allocated into the experimental condition and 72 into the active control condition. At baseline (Time 1) compared to those in the experimental group, those in the active control group had significantly higher levels of depressive symptoms and state anxiety, and lower levels of resilience. The active control group also had lower levels of the health status subscale social functioning. The groups did not differ on any other variables at baseline.

Time 1 (comparing completers and non-completers)

Those that did not complete the study (n = 72) had more body pain as measure by the SF-36 (a measure of health status), less physical health, and more state anxiety compared to those that completed Time 2 analyses. These are important findings as those with worse physical health may need additional resources to help them to make individual health behaviour changes.

Mental and physical health status outcomes

One way repeated measures analyses of variance indicated that for the two groups combined (experimental and active control) there were significant main effects of Time for depression, F(1, 73) = 10.01, p = .002, general health F(1, 74) = 5.17, p = .03, vitality F(1, 74) = 5.72, p = .02, physical health, F(1, 74) = 4.35, p = .04, mental health, F(1, 74) = 6.27, p = .01, total health status, F(1,74) = 5.20, p = .03, and fruit consumption, F(1, 71) = 6.01, p = .02. There were no significant interaction or between-subjects effects for any variable. These results indicate that overall there were improvements to depression levels, general health, vitality, physical health, mental health, total health status and an increase in fruit consumption from Time 1 to Time 2 for both groups.

Cost savings

For the experimental group, there was a decrease in mean cost for self-reported medical expenses for the previous month of $102.55 (SD = $638.59) and a mean increase of $5.97 (SD = $33.01) in self-reported cost of prescription medication for last month. Thirty-three percent of the group had a cost savings for each measure. For the active control group, there was an increase in mean cost for self-reported medical expenses for the previous month of $61.03 (SD = $298.05) and a mean increase of $7.91 (SD = $75.93) in self-reported cost of prescription medication for last month. Approximately, 30 percent of the group had a cost savings for each measure. Statistically, there were no significant differences between the two groups on either measure.

Change in health status and psychological factors: Reliable Change Index

For both groups, the rates of improvement were similar across physical and mental health status and resilience measures. More than one third of participants indicated clinical improvements in these measures. For the experimental group, among the coping resources subscales, the largest improvement occurred for physical coping resources subscale. For this measure, almost one third of individuals experienced a clinical improvement. For the active control group, among the coping resources subscales, physical coping resources also improved more than the other coping resources, with over 10 per cent of them experiencing a clinical improvement compared to the experimental group.

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