Self-management refers to the actions and skills through which individuals actively engage in coping with and regulating their chronic illnesses or symptoms in daily life (1). Such strategies are widely adopted by people living with chronic conditions, including diabetes (2), heart failure (3), emphysema (4), and asthma (5), and are known to contribute to healthier lifestyles and improved disease management. Importantly, self-management has been shown to enhance patients’ perceived control over their illness, a factor considered central to supporting personal recovery (6).

Self-management for coping with and managing symptoms is also essential for depression. The National Institute for Health and Care Excellence guidelines recommend self-management interventions, such as guided self-help, as an initial treatment option for non-severe depression (7). The Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 updated guidelines likewise emphasize the role of self-management in both the acute and maintenance phases of treatment for major depressive disorder (MDD) (8). Regarding the specific strategies employed by patients with depression, several investigations have been conducted. In one study, structured interviews with 20 patients in remission from MDD identified 50 distinct self-management strategies, whose utilization and perceived usefulness were subsequently evaluated in an additional 193 patients in remission (9, 10). Another study involving 25 patients with treatment-resistant depression identified 50 self-management strategies, of which 10 were regarded as particularly important (11). A review synthesizing 2214 self-help strategies from 93 sources identified 282 strategies considered useful for managing depressive symptoms (12). Among these, 48 strategies were endorsed by over 80% of 63 patients with depression and 34 mental health practitioners. The utilization and perceived usefulness of these strategies were further assessed in a large-scale online survey of 1,326 individuals with subthreshold depression (13). Across these studies, commonly endorsed strategies included engaging in physical activity, going out regularly, improving sleep hygiene and daily routines, ensuring adequate rest, and seeking support from trusted others.

However, most prior research has been conducted in Europe, North America, Australia, and New Zealand. Self-management strategies are likely to be shaped by cultural context and lifestyle, yet the practices of patients with depression in Asia have not been examined. In addition, variations in the use and perceived usefulness of self-management may depend on clinical symptoms and social functioning. Previous studies have generally focused on specific populations, such as patients in remission or those with treatment-resistant depression. As a result, little is known about how self-management is associated with clinical outcomes in broader patient populations.

The present study therefore aimed to identify the self-management strategies used by patients with depression in Japan and to evaluate their perceived usefulness in daily life. Additionally, the study sought to examine the associations between self-management and clinical outcomes by including patients at different phases of illness, from the acute phase to remission.

This study is the first cross-sectional survey to examine self-management strategies among patients with depression in Japan and to evaluate their perceived usefulness in daily life. Strategies such as “ensure enough rest to avoid exhaustion through overexertion”, “engage in moderate physical activity (e.g. cycling and walking)”, and “maintain a regular day–night rhythm” demonstrated both high utilization and usefulness rates. These findings underscore the importance of promoting adequate rest, physical activity, and lifestyle regularity as part of routine clinical care and psychoeducation for depression. Moreover, the number of strategies was positively associated with personal recovery. This finding suggests that having a broader repertoire of self-management strategies may be linked to with more favorable clinical outcomes in depression.

In this study, both lifestyle strategies, including rest, diet, exercise, and regulation of daily rhythms, and behavioral activation strategies, including engaging in leisure and enjoyable activities, were frequently used. Specifically, participants most often reported “ensure enough rest to avoid exhaustion through overexertion” (88.0%), “eat a healthy diet” (65.0%), “engage in moderate physical activity (e.g. cycling and walking)” (62.3%), “ensure I am awakened every morning” (59.0%), “maintain a regular day-night rhythm” (57.4%), “have daily exposure to natural sunlight” (55.7%), “engage in leisure activities (e.g. reading, watching TV, cooking, traveling, and driving)” (78.9%), and “do something I usually enjoy, even if I do not feel like it” (54.6%). The CANMAT 2023 updated guidelines recommend skills such as problem solving, lifestyle modification, and behavioral activation as important components of illness management. Similarly, the clinical guidelines for MDD by the Japanese Society of Mood Disorders emphasizes lifestyle modifications, especially sleep hygiene (16). These recommendations may help explain the high utilization rates of lifestyle and behavioral activation strategies observed in the present study. Furthermore, previous studies in other countries have also reported high utilization of these strategies, indicating that they are widely adopted by individuals with depression regardless of cultural background or treatment settings (10–13).

Regarding perceived usefulness, self-management strategies related to social connections and supportive relationships were among those rated most highly. For example, “discuss information about depression with a therapist” (86.7%), “meet with friends with whom I can be myself” (83.5%), “avoid or minimize contact with people who tend to make me stressed or depressed” (83.3%), “talk over problems or feelings with someone supportive and caring” (80.3%), and “avoid isolating myself” (77.8%) were rated “useful” by participants. A systematic review of longitudinal studies, including 23 reports sampling individuals with depression, found that loneliness and low social support were associated with poorer clinical outcomes (17). These findings highlight the importance of strategies that focus on seeking support from others and preventing loneliness. However, in our study, the utilization rates of such strategies were relatively low, suggesting that they are not widely adopted by patients with depression. This pattern may reflect tendencies toward social avoidance or self-stigma (18, 19), which are commonly observed in this population. Although these strategies appear useful, they are not sufficiently recognized by patients, and therefore greater efforts are needed to increase awareness and promote their dissemination. At the same time, initiatives that broaden access to supportive interpersonal environments in which individuals feel safe and accepted, together with guidance on building and maintaining relationships, may play an important role in facilitating the use of these strategies.

The number of self-management strategies reported as “used” was weakly positively correlated with the QPR-J scores. Furthermore, the number of self-management strategies rated as “useful” showed a significant moderate positive association with the QPR-J scores. These associations remained statistically significant in multivariable linear regression analyses after adjustment for potential confounders, indicating the robustness of the observed relationships. Although differences in correlation strength alone do not allow firm conclusions regarding differential clinical impact, the present findings consistently indicate that employing more self-management strategies perceived as effective, rather than simply employing many strategies, is associated with higher personal recovery. In recent studies, it has been emphasized that treatment of depression should move beyond the exclusive pursuit of clinical recovery. While symptom reduction remains a central treatment goal, it does not necessarily equate to recovery from the patient’s perspective, and growing evidence highlights the importance of personal recovery, which encompasses subjective well-being, meaning in life, and a sense of agency (20, 21). In this context, the present results indicate that self-management is relevant not only for alleviating depressive symptoms but also for promoting higher levels of personal recovery. The practice of self-management strategies might lead to changes in self-recognition and agency, thereby promoting personal recovery. Among individuals with depression who have achieved clinical recovery but remain dissatisfied with their current state, expanding the repertoire of self-management strategies can help facilitate a more meaningful and patient-centered form of recovery.

It is noteworthy that 79.8% of participants reported self-management as effective for depressed mood and 57.9% for anxiety, both of which are commonly experienced symptoms of depression. In contrast, lower effectiveness rates were observed for diminished concentration (10.9%), suicidal ideation (18.6%), and agitation (23.5%). While self-management may be well-suited for common affective and anxiety-related symptoms, it may have limited utility in addressing cognitive impairments, acute risk states, or severe agitation, which require professional intervention.

The present study has several limitations. First, all data were based on self-report, limiting the findings to subjective evaluations and potentially introducing recall bias in participants’ reports of self-management strategy use. Furthermore, self-reported date may be influenced by social desirability bias, potentially resulting in the overestimation of strategies perceived as beneficial and the underreporting of those considered less socially acceptable. Second, because strategies were selected based on previous international studies, self-management strategies specific to the Japanese cultural context might not have been captured. Future studies should incorporate qualitative approaches to identify culturally specific strategies. Third, our sample did not include younger or older populations. Given that self-management needs and capacities differ across the lifespan, inclusion of broader age groups is necessary to improve generalizability. Finally, the cross-sectional design of this study does not allow for causal interpretation of the relationships between self-management and clinical outcomes. In particular, the observed associations could reflect reverse causation, whereby individuals with less severe symptoms or higher levels of personal recovery are more likely to engage in self-management strategies and to experience greater perceived benefits. Longitudinal and interventional studies are required to examine the directionality of these associations.

In conclusion, the present study identified the self-management strategies employed by individuals with depression in Japan. It revealed that even strategies perceived as highly useful are not necessarily widely practiced, highlighting the importance of disseminating information about such strategies to patients. Moreover, the findings indicate that broadening the repertoire of self-management strategies is associated with higher levels of personal recovery. Future research should further explore how self-management strategies can be effectively integrated into routine clinical practice and psychoeducation programs.