BackgroundDepression is common in coronary heart disease (CHD) and increases the incidence of coronary symptoms and death in CHD patients. Interventions feasible for use in primary care are needed to improve both mood and cardiac outcomes. The UPBEAT-UK programme of research has been funded by the NHS National Institute for Health Research (NIHR) to explore the relationship between CHD and depression and to develop a new intervention for use in primary care.MethodsUsing the Medical Research Council (MRC) guidelines for developing and evaluating complex interventions, we conducted a systematic review and qualitative research to develop a primary care-based nurse-led intervention to improve mood and cardiac outcomes in patients with CHD and depression. Iterative literature review was used to synthesise our empirical work and to identify evidence and theory to inform the intervention.ResultsWe developed a primary care-based nurse-led personalised care intervention which utilises elements of case management to promote self management. Following biopsychosocial assessment, a personalised care plan is devised. Nurses trained in behaviour change techniques facilitate patients to address the problems important to them. Identification and utilisation of existing resources is promoted. Nurse time is conserved through telephone follow up.ConclusionsApplication of the MRC framework for complex interventions has allowed us to develop an evidence based intervention informed by patient and clinician preferences and established theory. The feasibility and acceptability of this intervention is now being tested further in an exploratory trial.

BackgroundCoronary heart disease and depression are both common health problems and by 2020 will be the two leading causes of disability worldwide. Depression has been found to be more common in patients with coronary heart disease but the nature of this relationship is uncertain. In the United Kingdom general practitioners are now being remunerated for case-finding for depression in patients with coronary heart disease, however it is unclear how general practitioners should manage these patients. We aim to explore the relationship between coronary heart disease and depression in a primary care population and to develop an intervention for patients with coronary heart disease and depression.Methods/designThis programme of research will consist of 4 inter-related studies. A 4 year prospective cohort study of primary care patients with coronary heart disease will be conducted to explore the relationship between coronary heart disease and depression. Within this, a nested case-control biological study will investigate genetic and blood-biomarkers as predictors of depression in this sample. Two qualitative studies, one of patients' perspectives of treatments for coronary heart disease and co-morbid depression and one of primary care professionals' views on the management of patients with coronary heart disease and depression will inform the development of an intervention for this patient group. A feasibility study for a randomised controlled trial will then be conducted.DiscussionThis study will provide information on the relationship between coronary heart disease and depression that will allow health services to determine the efficiency of case-finding for depression in this patient group. The results of the cohort study will also provide information on risk factors for depression. The study will provide evidence on the efficacy and feasibility of a joint patient and professional led intervention and data necessary to plan a definitive randomised controlled trial of the intervention.

IntroductionUniversity students face challenges when starting their careers and entering the workforce after tertiary education is associated with negative psychological outcomes. The planned scoping review will synthesise the literature on the impact of university-to-work transitions on the mental health of new and recent graduates. We will describe the characteristics and main findings of the studies, and will examine the variables associated with, and the theories used to explain, the relationship between transitions to work and graduates’ mental health.MethodsWe will search the following databases: Scopus, Web of Science, ERIC, PSYCINFO, Social Sciences Citation Index, CINAHL Plus, Ovid MEDLINE and Google Scholar, to locate published and unpublished literature. The included studies will focus on undergraduate and postgraduate university students during planned or current university-to-work transitions, as well as early-career workers. We will include studies involving people who have left or are in their final year of study, are undergoing career transition preparation or have worked for no longer than 3 years since graduation. Studies from all countries, those published in English and since 2000, will be included. We will use a set of predefined search terms and we will extract studies using the EndNote V.20 reference management software. Two reviewers will screen and assess the identified studies using the Covidence software. Finally, we will present the data in a summary table and will qualitatively analyse the studies using thematic analysis.Ethics and disseminationOur scoping review does not require ethical approval. The scoping review’s findings will be disseminated in peer-reviewed journal articles and conference presentations, and will inform the development of training resources for different stakeholders as part of a wider research project.Trial registration numberThe study has been registered with the Open Science Framework (https://osf.io/gw86x).

Forensic PD services may be having an important impact on the quality of service users' lives. Whether treatment is successful in reducing long-term risk to others remains to be seen, and the cost-effectiveness of these services needs to be examined.

BackgroundCommunity studies reveal people with coronary heart disease (CHD) are twice as likely to be depressed as the general population and that this co-morbidity negatively affects the course and outcome of both conditions. There is evidence for the efficacy of collaborative care and case management for depression treatment, and whilst NICE guidelines recommend these approaches only where depression has not responded to psychological, pharmacological, or combined treatments, these care approaches may be particularly relevant to the needs of people with CHD and depression in the earlier stages of stepped care in primary care settings.MethodsThis pilot randomised controlled trial will evaluate whether a simple intervention involving a personalised care plan, elements of case management and regular telephone review is a feasible and acceptable intervention that leads to better mental and physical health outcomes for these patients. The comparator group will be usual general practitioner (GP) care.81 participants have been recruited from CHD registers of 15 South London general practices. Eligible participants have probable major depression identified by a score of ≥8 on the Hospital Anxiety and Depression Scale depression subscale (HADS-D) together with symptomatic CHD identified using the Modified Rose Angina Questionnaire.Consenting participants are randomly allocated to usual care or the personalised care intervention which involves a comprehensive assessment of each participant’s physical and mental health needs which are documented in a care plan, followed by regular telephone reviews by the case manager over a 6-month period. At each review, the intervention participant’s mood, function and identified problems are reviewed and the case manager uses evidence based behaviour change techniques to facilitate achievement of goals specified by the patient with the aim of increasing the patient’s self efficacy to solve their problems.Depressive symptoms measured by HADS score will be collected at baseline and 1, 6- and 12 months post randomisation. Other outcomes include CHD symptoms, quality of life, wellbeing and health service utilisation.DiscussionThis practical and patient-focused intervention is potentially an effective and accessible approach to the health and social care needs of people with depression and CHD in primary care.Trial registrationISRCTN21615909.