Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom
BACKGROUND This study examines the relationship between patient activation, a measure of individuals׳ knowledge, skill, and confidence for managing their health, and rates of depression remission and response among patients with depression. METHODS Patients from Fairview Health Services in Minnesota with moderate to severe depression in 2011 and a PHQ-9 score in 2012 were included in the analysis (n=5253). Patient activation in 2011 and other health and demographic features were extracted from the electronic health record. We examined how patient activation predicted depression remission and response rates and changes in depression severity over one year using regression models. We also explored how activation predicted healthy behaviors among depressed patients. RESULTS Higher baseline patient activation predicted lower depression severity and higher depression remission and response rates a year later. The most activated patients had PHQ-9 scores in 2012 two points lower than the lowest activated patients, and they had twice the odds of remission. Activation also predicted increase in healthy behaviors. LIMITATIONS We were unable to examine the use of mental health services or control for the number of prior depressive episodes and duration of the current depressive episode in the analysis. CONCLUSIONS We found that higher patient activation predicted better depression outcomes. While we are unable to explore the mechanism of this association, we observed that more activated patients are also engaged in more healthy behaviors, suggesting that the mechanism may be behavioral. Support of patient activation may be an effective approach for providers to reduce patients׳ depression severity.