BACKGROUND: Common mental health problems account for up to 40% of all general practitioner (GP) consultations. Patients have limited access to evidence-based psychological therapies. Cognitive behavioural therapy self-help strategies offer one potential solution. AIM: To determine differences in clinical outcome, patient satisfaction and costs, between a cognitive behavioural-based self-help package facilitated by practice nurses compared to ordinary care by GPs for mild to moderate anxiety and depression. DESIGN OF STUDY: Randomised controlled trial. SETTING:Seventeen primary healthcare teams. METHOD:Patients presenting to their GP with mild to moderate anxiety and/or depression were recruited to the study and randomised to receive either a self-help intervention facilitated by practice nurses or ordinary care. The self-help intervention consisted of up to three appointments: two 1 week apart and a third 3 months later. There were no restrictions on ordinary care. RESULTS: Intention-to-treat analysis showed that patients treated with practice nurse-supported cognitive behavioural therapy self-help attained similar clinical outcomes for similar costs and were more satisfied than patients treated by GPs with ordinary care. On-treatment analysis showed patients receiving the facilitated cognitive behavioural therapy self-help were more likely to be below clinical threshold at 1 month compared to the ordinary care group (odds ratio [OR] = 3.65, 95% confidence interval [CI] = 1.87 to 4.37). This difference was less well marked at 3 months (OR = 1.36, 95% CI = 0.52 to 3.56). CONCLUSION: Facilitated cognitive behavioural self-help may provide a short-term cost-effective clinical benefit for patients with mild to moderate anxiety and depression. This has the potential to help primary care provide a choice of effective psychological as well as pharmacological treatments for mental health problems.
RCT Entities:
BACKGROUND: Common mental health problems account for up to 40% of all general practitioner (GP) consultations. Patients have limited access to evidence-based psychological therapies. Cognitive behavioural therapy self-help strategies offer one potential solution. AIM: To determine differences in clinical outcome, patient satisfaction and costs, between a cognitive behavioural-based self-help package facilitated by practice nurses compared to ordinary care by GPs for mild to moderate anxiety and depression. DESIGN OF STUDY: Randomised controlled trial. SETTING: Seventeen primary healthcare teams. METHOD:Patients presenting to their GP with mild to moderate anxiety and/or depression were recruited to the study and randomised to receive either a self-help intervention facilitated by practice nurses or ordinary care. The self-help intervention consisted of up to three appointments: two 1 week apart and a third 3 months later. There were no restrictions on ordinary care. RESULTS: Intention-to-treat analysis showed that patients treated with practice nurse-supported cognitive behavioural therapy self-help attained similar clinical outcomes for similar costs and were more satisfied than patients treated by GPs with ordinary care. On-treatment analysis showed patients receiving the facilitated cognitive behavioural therapy self-help were more likely to be below clinical threshold at 1 month compared to the ordinary care group (odds ratio [OR] = 3.65, 95% confidence interval [CI] = 1.87 to 4.37). This difference was less well marked at 3 months (OR = 1.36, 95% CI = 0.52 to 3.56). CONCLUSION: Facilitated cognitive behavioural self-help may provide a short-term cost-effective clinical benefit for patients with mild to moderate anxiety and depression. This has the potential to help primary care provide a choice of effective psychological as well as pharmacological treatments for mental health problems.
Authors: Greer Sullivan; Michelle G Craske; Cathy Sherbourne; Mark J Edlund; Raphael D Rose; Daniela Golinelli; Denise A Chavira; Alexander Bystritsky; Murray B Stein; Peter P Roy-Byrne Journal: Gen Hosp Psychiatry Date: 2007 Sep-Oct Impact factor: 3.238
Authors: Christopher Dowrick; Linda Gask; Suzanne Edwards; Saadia Aseem; Peter Bower; Heather Burroughs; Amy Catlin; Carolyn Chew-Graham; Pam Clarke; Mark Gabbay; Simon Gowers; Derek Hibbert; Marija Kovandzic; Jonathan Lamb; Karina Lovell; Anne Rogers; Mari Lloyd-Williams; Waquas Waheed Journal: BMC Health Serv Res Date: 2009-12-10 Impact factor: 2.655
Authors: Peter Bower; Evangelos Kontopantelis; Alex Sutton; Tony Kendrick; David A Richards; Simon Gilbody; Sarah Knowles; Pim Cuijpers; Gerhard Andersson; Helen Christensen; Björn Meyer; Marcus Huibers; Filip Smit; Annemieke van Straten; Lisanne Warmerdam; Michael Barkham; Linda Bilich; Karina Lovell; Emily Tung-Hsueh Liu Journal: BMJ Date: 2013-02-26
Authors: Christopher Williams; Philip Wilson; Jill Morrison; Alex McMahon; Andrew Walker; Walker Andrew; Lesley Allan; Alex McConnachie; Yvonne McNeill; Louise Tansey Journal: PLoS One Date: 2013-01-11 Impact factor: 3.240