Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-15T01:20:56.286Z Has data issue: false hasContentIssue false

Enhanced treatment for depression in primary care: long-term outcomes of a psycho-educational prevention program alone and enriched with psychiatric consultation or cognitive behavioral therapy

Published online by Cambridge University Press:  22 March 2007

HENK JAN CONRADI
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
PETER de JONGE
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
HERMAN KLUITER
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
ANNET SMIT
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands Gelderse Roos Institute for Professionalization Research, Wolfheze, The Netherlands
KLAAS van der MEER
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands Department of General Practice, University Medical Center Groningen, University of Groningen, The Netherlands
JACK A. JENNER
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands Mental Health Care Foundation Groningen, the Netherlands
TITUS W. D. P. van OS
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
PAUL M. G. EMMELKAMP
Affiliation:
Department of Clinical Psychology, University of Amsterdam, The Netherlands
JOHAN ORMEL
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands

Abstract

Background. The long-term outcome of major depression is often unfavorable, and because most cases of depression are managed by general practitioners (GPs), this places stress on the need to improve treatment in primary care. This study evaluated the long-term effects of enhancing the GP's usual care (UC) with three experimental interventions.

Method. A randomized controlled trial was conducted from 1998 to 2003. The main inclusion criterion was receiving GP treatment for a depressive episode. We compared: (1) UC (n=72) with UC enhanced with: (2) a psycho-educational prevention (PEP) program (n=112); (3) psychiatrist-enhanced PEP (n=37); and (4) brief cognitive behavioral therapy followed by PEP (CBT-enhanced PEP) (n=44). We assessed depression status quarterly during a 3-year follow-up.

Results. Pooled across groups, depressive disorder-free and symptom-free times during follow-up were 83% and 17% respectively. Almost 64% of the patients had a relapse or recurrence, the median time to recurrence was 96 weeks, and the mean Beck Depression Inventory (BDI) score over 12 follow-up assessments was 9·6. Unexpectedly, PEP patients had no better outcomes than UC patients. However, psychiatrist-enhanced PEP and CBT-enhanced PEP patients reported lower BDI severity during follow-up than UC patients [mean difference 2·07 (95% confidence interval (CI) 1·13–3·00) and 1·62 (95% CI 0·70–2·55) respectively] and PEP patients [2·37 (95% CI 1·35–3·39) and 1·93 (95% CI 0·92–2·94) respectively].

Conclusions. The PEP program had no extra benefit compared to UC and may even worsen outcome in severely depressed patients. Enhancing treatment of depression in primary care with psychiatric consultation or brief CBT seems to improve the long-term outcome, but findings need replication as the interventions were combined with the ineffective PEP program.

Type
Original Article
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)