Associations between self-management strategies and clinical outcomes in depression: a cross-sectional survey

Teruo Tada¹Hitoshi Sakurai^1*Taku Maruki¹Masami Murao¹Yasuyuki Matsumoto¹Yumi Aoki²Hisateru Tachimori³Yayoi Imamura¹Yu Matsumoto⁴Norifusa Sawada⁵Seiji Hongo⁶Sojiro Makino⁷Koji Tada⁸Takashi Tsuboi¹Koichiro Watanabe¹

• ¹Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
• ²Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
• ³Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
• ⁴Kitanara Ekiue Hotto Clinic, Chiba, Japan
• ⁵Mental and Sleep Clinic of Narimasu, Tokyo, Japan
• ⁶Ichigaya Himorogi Clinic, Tokyo, Japan
• ⁷Makino Clinic, Tokyo, Japan
• ⁸Jimbocho Mental Health Clinic, Tokyo, Japan

Background: Self-management is essential for coping with depressive symptoms, yet little is known about its associations with depressive symptoms and personal recovery. Methods: We conducted a cross-sectional questionnaire survey of 183 outpatients with major depressive disorder in Japan between October 2024 and June 2025. Participants reported the use and perceived usefulness of 63 self-management strategies. Associations between the number of strategies and symptom severity and recovery were examined using Spearman's rank correlation coefficients with the Japanese versions of the Quick Inventory of Depressive Symptomatology (QIDS-J) and the Questionnaire about the Process of Recovery (QPR-J). Results: Of the 183 respondents (mean age 43.6 ± 12.4 years; 54.1% female), the mean QIDS-J score was 9.55 ± 5.25 and 60.7% were in remission. Fourteen of the 63 strategies were used by at least half of the participants. The most frequently used strategies were "ensure enough rest to avoid exhaustion through overexertion" (88.0%), "engage in leisure activities (e.g. reading, watching TV, cooking, traveling, and driving)" (78.9%), and "eat a healthy diet" (65.0%). The strategies rated most useful included "discuss information about depression with a therapist" (86.7%), "meet with friends with whom I can be myself" (83.5%), and "avoid or minimize contact with people who tend to make me stressed or depressed" (83.3%). Participants reported using an average of 20.8 ± 13.5 strategies, of which 13.1 ± 9.16 were rated as useful. The number of strategies rated as useful was weakly negatively correlated with the QIDS-J scores (Spearman's ρ = −0.207, p = 0.006) and moderately positively correlated with the QPR-J scores (Spearman's ρ = 0.472, p < 0.001). Conclusion: The number of self-management strategies rated as useful showed a stronger correlation with personal recovery than with depressive symptom severity. The use of a greater number of self-management strategies may be associated with higher levels of personal recovery.