Effects of Coping, Affirmation, Resilience, and Empowerment (CARE)Program on Depression, Mental Health Literacy, and Coping Skills among People with Depression in Indonesia: A Mixed Methods Study

Abstract

Introduction: Coping, affirmation, resilience, and empowerment (CARE) program was designed to support patients with depression. We combined psychoeducation and coping skills to help people with depression cope with depressive symptoms and stressful life events. This study investigated the effects of CARE program on participants' depression scores reduction, mental health literacy, and coping skills improvement. Methods: A convergent parallel mixed-method study was conducted from February to July 2022 at two psychiatric units in Banjarmasin, Indonesia. A quasi-experimental study with two groups of pre- and post-tests (90 participants) and a qualitative study (40 participants from intervention group) were conducted simultaneously. Repeated measure analysis of variance was used to investigate effects of the program on depression scores. Thematic analysis method was used to analyze qualitative data. Results: Most participants were single females, with an average age of 23.99 years (standard deviation ± 3.93). There was a significant change in depression scores between the intervention and control groups over time (P < 0.001). At baseline (T1), there was no significant difference between the groups (P = 0.061). However, significant differences were observed at 2 months (T2) (P < 0.001) and 4 months (T3) (P < 0.001). Improvements in mental health literacy and coping skills included increased understanding of depression, medication adherence, self-care, emotion regulation, and various daily coping practices. Conclusion: CARE program positively impacts participants' depression scores reduction, mental health literacy, and coping skills improvement. Future studies should include self-efficacy and relapse prevention as additional outcomes.