Depression Outcomes in Adults Attending Family Practice Were Not Improved by Screening, Stepped-Care, or Online CBT during a 12-Week Study when Compared to Controls in a Randomized Trial

There is uncertainty regarding possible benefits of screening for depression in family practice, as well as the most effective treatment approach when depression is identified. Here, we examined whether screening patients for depression in primary care, and then treating them with different modalities, was better than treatment-as-usual (TAU) alone. Screening was carried out for depression using the 9-item Patient Health Questionnaire (PHQ-9), with a score of ≥10 indicating significant depressive symptoms. PHQ-9 scores were given to family physicians prior to patients being seen (except for the Control group). Patients ( n = 1,489) were randomized to one of four groups. Group #1 were controls ( n = 432) in which PHQ-9 was administered, but results were not shared. Group #2 was screening followed by TAU ( n = 426). Group #3 was screening followed by both TAU and the opportunity to use an online cognitive behavioral therapy (CBT) treatment program ( n = 440). Group #4 utilized an evidence-based Stepped-care pathway for depression ( n = 191, note that this was not available at all clinics). Of the study sample 889 (60%) completed a second PHQ-9 rating at 12 weeks. There were no statistically significant differences in baseline PHQ-9 scores between these groups. Compared to baseline, mean PHQ-9 scores decreased significantly in the depressed patients over 12 weeks, but there were no statistically significant differences between any groups at 12 weeks. Thus, for those who were depressed at baseline Control group (Group #1) scores decreased from 15.3 ± 4.2 to 4.0 ± 2.6 ( p p p p < 0.05). In conclusion, these findings from this controlled randomized study do not suggest that using depression screening tools in family practice improves outcomes. They also suggest that much of the depression seen in primary care spontaneously resolves and do not support suggestions that more complex treatment programs or pathways improve depression outcomes in primary care. Replication studies are required due to study limitations

Cognition · Cognitive behavioral therapy · Depression (economics · Depressive symptoms · Patient Health Questionnaire · Physical therapy · Psychiatry · Randomized controlled trial · Child and Adolescent Psychosocial and Emotional Development · Digital Mental Health Interventions · Medicine · Mental Health Treatment and Access · Internal Medicine

• Depression, chronic diseases, and decrements in health

  Open Access•Saba Moussavi, Somnath Chatterji et al.•The Lancet•2007

  Incluir item

• Screening for Depression in Adults

  Albert L Siu, and the US Preventive Services Task Force et al.•JAMA•2016

  Incluir item

• Measuring depression outcome with a brief self-report instrument

  Open Access•Bernd Löwe, Kurt Kroenke et al.•Journal of Affective Disorders•2004

  Incluir item

• The PHQ-9

  Kurt Kroenke, Robert L Spitzer et al.•Journal of General Internal…•2001

  Incluir item

• Quality improvement in depression care in the Netherlands

  Open Access•Gerdien Franx, Jolanda A C Meeuwissen et al.•International Journal of…•2009

  Incluir item