Short-term effects of enhanced treatment for depression in primary care: results from a randomized controlled trial

Background. Depression is a highly prevalent, often recurring or persistent disorder. The majority of patients are initially seen and treated in primary care. Effective treatments are available, but possibilities for providing adequate follow-up care are often limited in this setting. This study assesses the effectiveness of primary-care-based enhanced treatment modalities on short-term patient outcomes. Method. In a randomized controlled trial we evaluated a psycho-educational self-management intervention. We included 267 adult patients meeting criteria for a DSM-IV diagnosis of major depressive disorder, assessed by a structured psychiatric interview. Patients were randomly assigned to: the Depression Recurrence Prevention (DRP) program (n = 112); a combination of tile DRP program with psychiatric consultation (PC + DRP, n = 39); a combination with brief cognitive behavior therapy (CBT + DRP, n = 44); and care as usual (CAU, n = 72). Follow-up assessments were made at 3 months (response 90%) and 6 months (85%). Results. Patient acceptance of enhanced care was good. The mean duration of the index episode was 11 weeks (S.D. = 9.78) and similar in CAU and enhanced care. Recovery rate after 6 months was 67% overall; 17% of all participants remained depressed for the entire 6-month period. Conclusion. Enhanced care did not result in better short-term outcomes. We found no evidence that the DRP program was more effective than CAU and no indications for added beneficial effects of either tile psychiatric evaluation or the CBT treatment to the basic format of the DRP program. Observed depression treatment rates in CAU were high.