Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial

Abstract

Objectives To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function. Design A pragmatic multicentre randomised controlled trial, stratified by centre. Setting Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom. Participants 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Interventions Six individual sessions of problem solving treatment (n = 128), eight group sessions of the course on prevention of depression (n = 108), and controls (n = 189). Main outcome measures Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function. Results 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was -2.63 (95% confidence interval -4.95 to -0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome. Conclusions When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.

Conceptualizing changes in behavior in intervention research: The range of possible changes model.

“…Similar to our example of inconsistent findings in studies examining interventions for children, the efficacy of this adult intervention was both founded and unfounded across these two investigations. 3 Other studies examining the same psychological intervention for adult psychological constructs other than anxiety disorders (e.g., Coping with Depression Course; Brown & Lewinsohn, 1984;Dowrick et al, 2000), and other forms of intervention (e.g., acamprostate for alcohol dependence; Chick, Howlett, Morgan, & Ritson, 2000;Tempesta, Janiri, Begnamini, Chabec, & Potgieter, 2000) convey the same point. Again, inconsistent findings made across two (or more) studies of the same intervention present difficulties in concluding that the intervention changes the targeted construct.…”

The Evolving Understanding of Major Depression Epidemiology: Implications for Practice and Policy

“…30 The NICE guidelines identify psychological treatment specifically focused on depression, such as problem solving therapy and brief CBT, as treatment options for mild and moderate depression. 31 According to Bilsker et al, 32 nearly 10% of the population visit a physician for depression in a given year, yet most receive less than 3 visits. An inadequate number of visits, relative to clinical practice guideline recommendations, has been regarded as an indication of inadequate treatment by some authors.…”

Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals.

“…The Outcomes of Depression International Network (ODIN; Dowrick et al, 1998Dowrick et al, , 2000 was the first international, community-based, randomized controlled trial of psychological interventions for depression. The study employed an epidemiological sampling frame to identify probable cases of depression and a randomized controlled design to assess the relative efficacy of two therapies.…”

“…Unfortunately, the study design did not permit a balanced comparison of the relative efficacy of the two therapeutic approaches, in that treatment modality (individual versus group) was confounded with treatment content (problem solving versus the DPC). The individual treatment had the advantage of greater accessibility because it was frequently offered in participants' homes, whereas the DPC required travel to a mental health clinic (Dowrick et al, 2000). In addition, the individual format may have been less stigmatizing and more culturally acceptable to certain participants, particularly in small rural communities.…”