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Short-term effects of enhanced treatment for depression in primary care: results from a randomized controlled trial

Published online by Cambridge University Press:  16 December 2005

A. SMIT
Affiliation:
Department of Psychiatry, University of Groningen, Groningen, The Netherlands Gelderse Roos Institute for Professionalization Research, Wolfheze, The Netherlands School of Behavioral and Cognitive Neurosciences (BCN), University of Groningen, Groningen, The Netherlands School of Experimental Psychopathology (EPP), Maastricht University, Maastricht, The Netherlands
H. KLUITER
Affiliation:
Department of Psychiatry, University of Groningen, Groningen, The Netherlands
H. J. CONRADI
Affiliation:
Department of Psychiatry, University of Groningen, Groningen, The Netherlands School of Behavioral and Cognitive Neurosciences (BCN), University of Groningen, Groningen, The Netherlands School of Experimental Psychopathology (EPP), Maastricht University, Maastricht, The Netherlands
K. VAN DER MEER
Affiliation:
Department of Psychiatry, University of Groningen, Groningen, The Netherlands Department of General Practice, University of Groningen, Groningen, The Netherlands
B. G. TIEMENS
Affiliation:
Gelderse Roos Institute for Professionalization Research, Wolfheze, The Netherlands
J. A. JENNER
Affiliation:
Department of Psychiatry, University of Groningen, Groningen, The Netherlands Mental Health Care Foundation Groningen, The Netherlands
T. W. D. P. VAN OS
Affiliation:
Department of Psychiatry, University of Groningen, Groningen, The Netherlands
J. ORMEL
Affiliation:
Department of Psychiatry, University of Groningen, Groningen, The Netherlands School of Behavioral and Cognitive Neurosciences (BCN), University of Groningen, Groningen, The Netherlands School of Experimental Psychopathology (EPP), Maastricht University, Maastricht, The Netherlands

Abstract

Background. Depression is a highly prevalent, often recurring or persistent disorder. The majority of patients are initially seen and treated in primary care. Effective treatments are available, but possibilities for providing adequate follow-up care are often limited in this setting. This study assesses the effectiveness of primary-care-based enhanced treatment modalities on short-term patient outcomes.

Method. In a randomized controlled trial we evaluated a psycho-educational self-management intervention. We included 267 adult patients meeting criteria for a DSM-IV diagnosis of major depressive disorder, assessed by a structured psychiatric interview. Patients were randomly assigned to: the Depression Recurrence Prevention (DRP) program (n=112); a combination of the DRP program with psychiatric consultation (PC+DRP, n=39); a combination with brief cognitive behavior therapy (CBT+DRP, n=44); and care as usual (CAU, n=72). Follow-up assessments were made at 3 months (response 90%) and 6 months (85%).

Results. Patient acceptance of enhanced care was good. The mean duration of the index episode was 11 weeks (S.D.=9·78) and similar in CAU and enhanced care. Recovery rate after 6 months was 67% overall; 17% of all participants remained depressed for the entire 6-month period.

Conclusion. Enhanced care did not result in better short-term outcomes. We found no evidence that the DRP program was more effective than CAU and no indications for added beneficial effects of either the psychiatric evaluation or the CBT treatment to the basic format of the DRP program. Observed depression treatment rates in CAU were high.

Type
Original Article
Copyright
2005 Cambridge University Press

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