Evaluation of a system of structured, pro-active care for chronic depression in primary care: a randomised controlled trial

Buszewicz, Marta; Griffin, Mark; McMahon, Elaine M.; Beecham, Jennifer; King, Michael
January 2010
BMC Psychiatry;2010, Vol. 10, p61
Academic Journal
Background: People with chronic depression are frequently lost from effective care, with resulting psychological, physical and social morbidity and considerable social and financial societal costs. This randomised controlled trial will evaluate whether regular structured practice nurse reviews lead to better mental health and social outcomes for these patients and will assess the cost-effectiveness of the structured reviews compared to usual care. The hypothesis is that structured, pro-active care of patients with chronic depression in primary care will lead to a cost-effective improvement in medical and social outcomes when compared with usual general practitioner (GP) care. Methods/Design: Participants were recruited from 42 general practices throughout the United Kingdom. Eligible participants had to have a history of chronic major depression, recurrent major depression or chronic dsythymia confirmed using the Composite International Diagnostic Interview (CIDI). They also needed to score 14 or above on the Beck Depression Inventory (BDI-II) at recruitment. Once consented, participants were randomised to treatment as usual from their general practice (controls) or the practice nurse led intervention. The intervention includes a specially prepared education booklet and a comprehensive baseline assessment of participants' mood and any associated physical and psycho-social factors, followed by regular 3 monthly reviews by the nurse over the 2 year study period. At these appointments intervention participants' mood will be reviewed, together with their current pharmacological and psychological treatments and any relevant social factors, with the nurse suggesting possible amendments according to evidence based guidelines. This is a chronic disease management model, similar to that used for other long-term conditions in primary care. The primary outcome is the BDI-II, measured at baseline and 6 monthly by self-complete postal questionnaire. Secondary outcomes collected by self-complete questionnaire at baseline and 2 years include social functioning, quality of life and data for the economic analyses. Health service data will be collected from GP notes for the 24 months before recruitment and the 24 months of the study. Discussion: 558 participants were recruited, 282 to the intervention and 276 to the control arm. The majority were recruited via practice database searches using relevant READ codes. Trial registration: ISRCTN36610074.


Related Articles

  • WIVES OF ALCOHOLICS: FAMILY RELATIONSHIPS AND MENTAL HEALTH. de Souza, Joseane; Pimenta Carvalho, Ana Maria; Martins Teodoro, Maycoln Lêoni // SMAD Revista Electronica Salud Mental, Alcohol y Drogas;Sep-Dec2012, Vol. 8 Issue 3, p127 

    Wives of alcoholics have been identified in the literature as being more vulnerable to the development of some psychiatric disorders such as depression. The study aimed to describe: socio-demographic characteristics, relationship with her husband and son and family history of wives of...

  • Depression and 'hassles' in globus pharyngis. Deary, Ian J.; Smart, Astrid; Wilson, Janet A.; Deary, I J; Smart, A; Wilson, J A // British Journal of Psychiatry;Jul92, Vol. 161, p115 

    A group of 25 patients (16 women, 9 men) attending an ENT department with globus sensation and 25 matched ENT controls were assessed using the Beck Depression Inventory and scales for daily stressful events ('hassles'). Globus patients of both sexes were significantly more depressed than...

  • Dysfunctional Attitudes and Early Maladaptive Schemas as Predictors of Depression: A 9-Year Follow-Up Study. Halvorsen, Marianne; Wang, Catharina E.; Eisemann, Martin; Waterloo, Knut // Cognitive Therapy & Research;Aug2010, Vol. 34 Issue 4, p368 

    The Dysfunctional Attitude Scale (DAS) and the Young Schema Questionnaire (YSQ) have been suggested as vulnerability markers for depression and entrenched psychological disorders, respectively. One-hundred-and-fifteen clinically depressed (CDs), previously depressed (PDs), and never depressed...

  • The Adolescent Depression Rating Scale (ADRS): a validation study. Revah-Levy, Anne; Birmaher, Boris; Gasquet, Isabelle; Falissard, Bruno // BMC Psychiatry;2007, Vol. 7, p2 

    Background: To examine the psychometric properties of the Adolescent Depression Rating Scale (ADRS), a new measure was specifically designed to evaluate adolescent depression. Methods: The 11-item clinician-report and 44-item self-report versions of the ADRS were developed from a qualitative...

  • CRITERIOS Y BAREMOS PARA INTERPRETAR EL "INVENTARIO DE DEPRESIÓN DE BECK-II" (BDI-II). Sanz, Jesús; Gutiérrez, Sara; Gesteira, Clara; García-Vera, María Paz // Behavioral Psychology / Psicologia Conductual;2014, Vol. 22 Issue 1, p37 

    This paper reports two studies providing criteria and norms to interpret scores on the Spanish adaptation of the BDI-II. The first study was aimed at validating the original BDI-II cut-off scores to distinguish levels of depression severity and at finding the best cut-off scores for the Spanish...

  • Psychological Symptom Clusters, Psychiatric Comorbidity and Poor Self-Reported Health Status Following Myocardial Infarction. Martens, Elisabeth J.; Smith, Otto R. F.; Denollet, Johan // Annals of Behavioral Medicine;2007, Vol. 34 Issue 1, p87 

    Background: Depression is a risk factor for adverse outcomes following myocardial infarction (MI). However, the importance of various other psychological factors is less well established. Purpose: The purpose is (a) explore the degree to which self-reported psychological symptoms in post-MI...

  • Psychiatric disorders and depression in multiple sclerosis outpatients: impact of disability and interferon beta therapy. Galeazzi, G. M.; Ferrari, S.; Giaroli, G.; Mackinnon, A.; Merelli, E.; Motti, L.; Rigatelli, M. // Neurological Sciences;Oct2005, Vol. 26 Issue 4, p255 

    Associations between psychopathology and gender, duration of MS, disability and therapy with beta-interferons were studied in multiple sclerosis (MS) outpatients. A controlled descriptive epidemiological study was carried out in two Italian outpatient MS centres on 50 outpatients with clinically...

  • Domínios de esquemas precoces na depressão. Claudio, Victor // Análise Psicológica;Apr-Jun2009, Vol. 27 Issue 2, p143 

    In this study we have a dual purpose: (1)to identify areas for maladaptive schemas of psychological functioning that are related to major depression and panic disorder, and (2) to study the areas of maladaptive schemas, characteristic of major depression. Participants were divided into three...

  • The Impact of Well - Being Therapy on Symptoms of Depression. Moeenizadeh, Majid; Salagame, Kiran Kumar K. // International Journal of Psychological Studies;Dec2010, Vol. 2 Issue 2, p223 

    Well Being Therapy (WBT) is a relatively modern technique of managing patients with Depression. Many studies and researches have been conducted in this field to formally found the Positive Psychology, the goal of which is to study the nature of wellbeing and the conditions, which stimulate them....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics