Effective management of depression in primary care: a review of the literature

Arroll, Bruce; Moir, Fiona; Kendrick, Tony

doi:10.3399/bjgpopen17x101025

Cited by 7 publications

(9 citation statements)

References 24 publications

(23 reference statements)

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“…Moreover, the effectiveness of Internet-based treatments for this disorder has also been demonstrated, and this kind of protocol can help to spread evidence-based treatments, so that more people can benefit from them [21, 70]. Specifically, mindfulness has been proposed as a potential non-drug therapy for mild-to-moderate depression [71] and for preventing depression relapses [72]. The study of mindfulness-based online interventions is increasing due to their good results and the benefits that have begun to be observed [27, 31].…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of a brief psychological mindfulness-based intervention for the treatment of depression in primary care: study protocol for a randomized controlled clinical trial

et al. 2019

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Background Depressive symptoms are quite prevalent in Primary Care (PC) settings. The treatment as usual (TAU) in PC is pharmacotherapy, despite the high relapse rates it produces. Many patients would prefer psychotherapy, but specialized services are overloaded. Studies that apply Mindfulness-Based Interventions (MBIs) for the treatment of depression have obtained significant improvements. Brief low-intensity approaches delivered from PC could be a promising approach. This study aims to compare a low-intensity mindfulness intervention for the treatment of depression in PC using different intervention formats – a face-to-face MBI delivered in a group and the same MBI individually applied on the Internet – to a control group that will receive PC medical treatment as usual. Methods A randomized controlled clinical trial will be conducted in PC, with about 120 depressed patients allocated (1:1:1) to three groups: “face-to-face MBI + TAU”, “Internet-delivered MBI + TAU”, and “TAU alone”. The MBI programs will be composed of four modules. The primary outcome will be depressive symptoms, measured through the Beck Depression Inventory, assessed at pre- and post-treatment and 6- and 12-month follow-ups. Other outcomes will be mindfulness, happiness, affectivity, quality of life, and the use of healthcare services. Intention-to-treat analysis using linear mixed models adjusted for baseline scores and routine sociodemographic analysis that could show baseline differences will be conducted. Per-protocol secondary outcome analyses will also be performed. Discussion This is the first Spanish RCT to apply a low-intensity face-to-face MBI (plus TAU) to treat depression in PC settings compared to TAU (alone). Moreover, this study will also make it possible to evaluate the same MBI program (plus TAU), but Internet-delivered, considering their cost-effectiveness. Positive results from this RCT might have an important impact on mental health settings, helping to decrease the overload of the system and offering treatment alternatives beyond antidepressant medication through high-quality, flexible PC interventions. Trial registration Clinical Trials.gov NCT03034343. Trial Registration date 24 January 2017, retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

“…Thus, although this study focuses mainly on depression, this proposal could also be used as a trans-diagnostic protocol in other comorbid psychological problems or emotional disorders (e.g. anxiety disorders) [71]. However, this is a brief treatment protocol, and research should be carried out in this regard.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a brief psychological mindfulness-based intervention for the treatment of depression in primary care: study protocol for a randomized controlled clinical trial

et al. 2019

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“…However, we found that previous treatment with medication markedly increased odds for preferring medication in the future. GPs should consider such differences in treatment preferences to reduce treatment barriers 17 .…”

Section: Implications For Research and Practicementioning

confidence: 99%

“…when initial care is unsuccessful, the GP refers the patient to a psychologist or psychiatrist for specialised mental health care. In such cases, the GP is supposed to continue following up the patient alongside treatment from other helpers 11,17,18 . In Norway a referral from a GP is mandatory for refundable help from psychologist or psychiatrist usually working together in hospitals, outpatient clinics, or practices that are private but contracted to the public health system.…”

Section: Introductionmentioning

confidence: 99%

Patient-reported depression treatment and future treatment preferences: an observational study in general practice

Hetlevik¹,

Garre-Fivelsdal²,

Bjorvatn

et al. 2019

Family Practice

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Background Depression is prevalent in general practice, but few studies have explored patient-reported depression care. Aim To investigate patient-reported treatment received for depression and future treatment preferences among adult patients visiting their GP, and to evaluate the associations with sex, age and educational level. Design and Setting A cross-sectional survey was conducted in general practices in Norway from 2016 to 2017. Methods Altogether, 2335 consecutive patients (response rate, 89.2%) in the GPs’ waiting rooms answered a questionnaire about their received depression treatment and treatment preferences in case of future depression. Results The study population (N = 2239) had a mean age of 48.6 ± 17.7 years (range 18–91), 60.1% were women. Of the 770 patients reporting to have received depression treatment, 39.1% were treated exclusively by their GP while 52.5% also were referred to a psychologist/psychiatrist. Older age was positively associated with medication and negatively associated with referrals to psychologist/psychiatrist. People with high education had lower odds for receiving medication (odds ratios [OR], 0.49; 95% confidence intervals [CI]: 0.30–0.80) compared to those with low education. If future depression, 81.6% of the respondents would discuss this with their GP, 60.9% would prefer talking therapy with their GP, 22.5% medication, and 52.9% referral to psychologist or psychiatrist. Conclusion One-third of the patients attending their GPs had consulted with them at some time concerning depression the case of future depression, most patients preferred talking therapy with the GP. This finding warrants increased research focus on the GP’s role in depression care.

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“…The results indicate that 3% of HCP reported symptoms of moderately severe/severe depression, which requires urgent intervention using antidepressants, psychotherapy, or a combination of both. 7 Severe depression that goes untreated can provoke episodes of deliberate self-harm. 8 Physicians already represent a vulnerable demographic for suicide, which is magnified in the current climate.…”

mentioning

confidence: 99%

Comments on “Prevalence and Predictors of Stress, Anxiety and Depression Among Health Care Workers Managing COVID-19 Pandemic in India: A Nation-Wide Observational Study”

Philip

Cherian

2020

Indian Journal of Psychological Medicine

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Effective management of depression in primary care: a review of the literature

Cited by 7 publications

References 24 publications

Effectiveness of a brief psychological mindfulness-based intervention for the treatment of depression in primary care: study protocol for a randomized controlled clinical trial

Effectiveness of a brief psychological mindfulness-based intervention for the treatment of depression in primary care: study protocol for a randomized controlled clinical trial

Patient-reported depression treatment and future treatment preferences: an observational study in general practice

Comments on “Prevalence and Predictors of Stress, Anxiety and Depression Among Health Care Workers Managing COVID-19 Pandemic in India: A Nation-Wide Observational Study”

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