The PHQ9 is acceptable, and as good as longer clinician-administered instruments in a range of settings, countries, and populations. More research is needed to validate the PHQ2 to see if its diagnostic properties approach those of the PHQ9.

on behalf of the REEACT Team ABSTRACT Study queStionHow effective is supported computerised cognitive behaviour therapy (cCBT) as an adjunct to usual primary care for adults with depression? MethodSThis was a pragmatic, multicentre, three arm, parallel randomised controlled trial with simple randomisation. Treatment allocation was not blinded. Participants were adults with symptoms of depression (score ≥10 on nine item patient health questionnaire, PHQ-9) who were randomised to receive a commercially produced cCBT programme ("Beating the Blues") or a free to use cCBT programme (MoodGYM) in addition to usual GP care. Participants were supported and encouraged to complete the programme via weekly telephone calls. Control participants were offered usual GP care, with no constraints on the range of treatments that could be accessed. The primary outcome was severity of depression assessed with the PHQ-9 at four months. Secondary outcomes included health related quality of life (measured by SF-36) and psychological wellbeing (measured by CORE-OM) at four, 12, and 24 months and depression at 12 and 24 months. Study anSwer and liMitationSParticipants offered commercial or free to use cCBT experienced no additional improvement in depression compared with usual GP care at four months (odds ratio 1.19 (95% confidence interval 0.75 to 1.88) for Beating the Blues v usual GP care; 0.98 (0.62 to 1.56) for MoodGYM v usual GP care). There was no evidence of an overall difference between either programme compared with usual GP care (0.99 (0.57 to 1.70) and 0.68 (0.42 to 1.10), respectively) at any time point. Commercially provided cCBT conferred no additional benefit over free to use cCBT or usual GP care at any follow-up point. Uptake and use of cCBT was low, despite regular telephone support. Nearly a quarter of participants (24%) had dropped out by four months. The study did not have enough power to detect small differences so these cannot be ruled out. Findings cannot be generalised to cCBT offered with a much higher level of guidance and support.

isrctn.com Identifier: ISRCTN50850043.

No abstract

The advantage of using the between approach to set targets and monitor progress is that it mirrors the long used and familiar health inequality measure of the standardised mortality ratio. However, we join Shaw et al in questioning whether this conventional approach is fit for purpose.Most descriptions of the national inequality targets do not specify whether the reductions required are relative or absolute, as if it does not matter. We have shown why it does matter. Moreover, lack of transparency in this regard has led to the inconsistent use of relative and absolute gaps in government targets going unquestioned. It has also resulted in confusion over how to establish local health improvement targets that are consistent with national policy on reducing health inequalities. Research methods Reporting attrition in randomised controlled trialsJo C Dumville, David J Torgerson, Catherine E Hewitt Loss to follow-up can greatly affect the strength of a trial's findings. But most reports do not give readers enough information for them to be able to understand the potential effects