Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care – does it really make a difference? A randomised controlled study

Abstract

BackgroundLittle information is available about whether the use of self-assessment instruments in primary care affects depression course and outcome. The purpose was to evaluate whether using a depression self-rating scale in recurrent person-centred GP consultations affected depression severity, quality of life, medication use, and sick leave frequency.MethodsPatients in the intervention group met their GP regularly at least 4 times during the 3 months intervention. In addition to treatment as usual (TAU), patients completed a self-assessment instrument (Montgomery-Asberg Depression Rating Scale) on each occasion, and then GPs used the completed instrument as the basis for a person-centred discussion of changes in depression symptoms. The control group received TAU. Frequency of visits in the TAU arm was the result of the GPs’ and patients’ joint assessments of care need in each case.Depression severity was measured with Beck Depression Inventory-II (BDI-II), quality of life with EQ-5D, and psychological well-being with the General Health Questionnaire-12 (GHQ-12). Data on sick leave, antidepressant and sedatives use, and care contacts were collected from electronic patient records. All variables were measured at baseline and 3, 6, and 12 months. Mean intra-individual changes were compared between the intervention and TAU group.ResultsThere were no significant differences between the intervention and control group in depression severity reduction or remission rate, change in quality of life, psychological well-being, sedative prescriptions, or sick leave during the whole 12-month follow-up. However, significantly more patients in the intervention group continued antidepressants until the 6 month follow-up (86/125 vs 78/133, p < 0.05).ConclusionsWhen GPs used a depression self-rating scale in recurrent consultations, patients more often continued antidepressant medication according to guidelines, compared to TAU patients. However, reduction of depressive symptoms, remission rate, quality of life, psychological well-being, sedative use, sick leave, and health care use 4-12 months was not significantly different from the TAU group. These findings suggest that frequent use of depression rating scales in person-centred primary care consultations has no further additional effect on patients’ depression or well-being, sick leave, or health care use.Trial registrationClinicalTrials.gov Identifier: NCT01402206. Registered June 27 2011(retrospectively registered).Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0578-9) contains supplementary material, which is available to authorized users.

Do PROMS improve outcomes in patients with depression in primary care?

“…Two recent trials in primary care have reported conflicting findings on the value of PROMS in improving depression symptoms 910. These studies were both small and probably underpowered to detect clinically meaningful changes in outcomes.…”

Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review

“…In paper 1, the participants were recruited from two areas: the city of Gothenburg and its suburbs, and the middle-sized town of Skövde with rural surroundings. In Gothenburg, the FPs were recruited from an on-going RCT that evaluated whether the use of a self-rating questionnaire for severity of depression had any impact on patient outcomes [147]. All FPs had undergone a ½ day training with an experienced colleague, but not all had been in the intervention group and used the questionnaire.…”

Patient-reported outcome measures for monitoring primary care patients with depression (PROMDEP): study protocol for a randomised controlled trial

“…Patients can feel more involved in their care and more motivated to adhere to treatment and followup [23,24]. Primary care patients in Sweden monitored with the Montgomery-Asberg rating scale were more likely to adhere to antidepressants, but no improvements in outcome were observed in that study [25], so findings are variable and more research needed.…”