A randomised controlled trial of an educational intervention for depression among Asian women in primary care in the United Kingdom

Objective: To determine the effect of patient education on patient perspectives and outcome of depression in a sample of Asian women in primary care. Design: A randomised, clinical trial of "patient education" versus "usual care". Setting: A general practice in London, which has a high proportion of Asians. Subjects: Seventy patients with psychiatric morbidity (a score of 3 or more on the General Health Questionnaire 12) were recruited for the trial. Outcome measures: Patient's explanatory models of illness (the patient's perspective on depression; recognition of depression as illness and recommend a medical intervention for this condition) and psychiatric morbidity at follow-up after two months were the primary outcome measures. Results: One hundred and fifty-five women of Asian decent were contacted. One hundred and forty-eight (95.5%) agreed to take part in the study. Seventy (47.3%) were classed as cases of common mental disorder using the General Health Questionnaire 12. Thirty-five were randomly allocated to receive education about the nature, causes, prevalence and treatment of depression, 35 did not receive such information. There were no statistical differences between the two groups on baseline characteristics. Sixty-six (94.3%) subjects were followed up at two months. An intention to treat analysis showed that there was no difference in explanatory model measures between the two groups at the end of the study. However, more patients who received education were no longer cases (a score of 2 or less on the GHQ) (15/35; 42.9%) compared to controls (7/35; 20%) (p < 0.05) as did those with lower GHQ scores at entry (p < 0.03). Receipt of educational intervention (OR 3.4; 95% Cl 1.01, 11.5) and lower GHQ scores at entry (OR 7.1; 95% Cl 1.05, 30.2) remained significantly associated with recovery after adjusting for baseline variables using logistic regression. Conclusions: Patients with common mental disorders, especially those with milder forms of the condition, who received the educational material had a higher recovery rate than patients who do not receive such education. The mechanism for this improvement was unclear, not being reflected in patient's apparent understanding of depression nor explained by change in general practitioner's response. The results of this study need to be replicated.