Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials
ABSTRACT Various studies have tested psychological therapies in the treatment of depression in primary care. Yet, concerns over their clinical effectiveness, as compared to usual general practitioner (GP) care or treatment with antidepressants, have been raised. The present meta-analysis was aimed at assessing currently available evidence on the topic.
A systematic search of electronic databases identified 10 randomized controlled trials comparing psychological forms of intervention with either usual GP care or antidepressant medication for major depression. Meta-analytical procedures were used to examine the impact of psychological intervention in primary care on depression, as compared to usual GP care and antidepressant treatment.
The main analyses showed greater effectiveness of psychological intervention over usual GP care in both the short term [standardized mean difference (SMD)=-0.42, 95% confidence interval (CI)=-0.59 to -0.26, n=408] and long term (SMD=-0.30, 95% CI=-0.45 to -0.14, n=433). The heterogeneity test was not significant in the short term at the P<.05 level (df=5, P=.57, I(2)=0%), but it was significant in the long term (df=5, P=.004, I(2)=70.9%). The comparison between psychological forms of intervention and antidepressant medication yielded no effectiveness differences, for either the short term or the long term.
Psychological forms of intervention are significantly linked to clinical improvement in depressive symptomatology and may be useful for supplementing usual GP care.
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ABSTRACT: Objectives: This is a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness of collaborative care compared to Primary Care Physician's (PCP's) usual care in the treatment of depression, focusing on European countries. Methods: A systematic review of English and non-English articles, from inception to March 2014, was performed using database PubMed, British Nursing Index and Archive, Ovid Medline (R), PsychINFO, Books@Ovid, PsycARTICLES Full Text, EMBASE Classic + Embase, DARE (Database of Abstract of Reviews of Effectiveness) and the Cochrane Library electronic database. Search term included depression, collaborative care, physician family and allied health professional. RCTs comparing collaborative care to usual care for depression in primary care were included. Titles and abstracts were independently examined by two reviewers, who extracted from the included trials information on participants' characteristics, type of intervention, features of collaborative care and type of outcome measure. Results: The 17 papers included, regarding 15 RCTs, involved 3240 participants. Primary analyses showed that collaborative care models were associated with greater improvement in depression outcomes in the short term, within 3 months (standardized mean difference (SMD) -0.19, 95% CI = -0.33; -0.05; p = 0.006), medium term, between 4 and 11 months (SMD -0.24, 95% CI = -0.39; -0.09; p = 0.001) and medium-long term, from 12 months and over (SMD -0.21, 95% CI = -0.37; -0.04; p = 0.01), compared to usual care. Conclusions: The present review, specifically focusing on European countries, shows that collaborative care is more effective than treatment as usual in improving depression outcomes.Journal of Psychosomatic Research 08/2014; 77(4). DOI:10.1016/j.jpsychores.2014.08.006 · 2.84 Impact Factor
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ABSTRACT: Objectives: A high demand for the inclusion of psycho-social interventions for primary care mental health presentations has become more apparent in recent years. Current policies have proposed models of care highlight-ing principles required for a quality service. However, implementation has been slow to date. This article aims to inform the current debate relating to primary care serv-ice delivery models for mental health presentations and to contribute towards future planning initiatives. Method: A narrative review of a range of policies and selected articles relevant to primary care mental health in an Irish context. Results: The search produced four distinct themes: current service provision in Ireland; stakeholders' views; psychological care options; and potential service struc-tures. Thereafter, a potential service delivery model is proposed. This formulated model employs a combination of elements from the reviewed themes to provide a clini-cally-and cost-effective, equitable and accessible service driven by service user and carer input. Conclusions: Although this review was selective in nature, the proposed potential model can complement future research agendas for more favourable primary care practice in Ireland. Recommendations are made for the planning of services including policy implementation procedures, training and communication. Introduction There is a pressing need for further development of robust primary care mental health services in Ireland. 1 While these services have to accommodate mild-to-moderate mental health presentations, 2 they also have to manage, independ-ent of secondary care services, up to 30% of severe and enduring mental health presentations. 3 However, with such a challenging agenda for change, 4 consensus is lacking on the most effective model of primary care mental health service provision. 5 This article aims to complement current research relating to primary care mental health service delivery by providing a narrative review of a recent range of policies and selected research relevant to the Irish context. The distinct themes that emerged will be discussed in turn. First, the current service provision, related policies, and the perspectives of signifi-cant stakeholders in Ireland will be profiled. Following a brief review of three widely used psychological interventions, serv-ice structures and models of service delivery are considered. A potential service model is then presented.