Indirect Evidence: Interventions in Primary Care for Adult Depression

StudyDesignBrief Description of InterventionPopulationSample SizeLength of Follow-UpSummary of Results
Cooper and Murray, 199727aRCTCounseling vs CBT vs dynamic therapy (1 specialist, 1 generalist providing each) vs routine primary careMothers suffering from postpartum depression19118 moSmall improvements in mother-child interaction over time, not related to receipt of treatment; No relationship between cognitive development and receipt of treatment; No relationship between behavior problems and receipt of treatment
Mynors-Wallis et al, 199529RCTProblem-solving treatment (6 sessions over 3 mo) vs amitriptyline vs usual care, conducted by 2 GPs and 1 psychiatristAdults with major depression recruited from general practice776 and 12 wkProblem-solving treatment was significantly superior to placebo at 6 and 12 wk
Mynors-Wallis et al, 200028RCTProblem solving by research GP or research practice nurse vs antidepressant vs combinationAdults with major depression recruited from general practice1166 and 12 and 52 wkPatients in all groups showed a clear improvement over 12 wk; No difference in outcome irrespective of who delivered the problem solving treatment.
Oxman et al, 200130RCT2–4 h of problem-solving treatment vs paroxetine vs placebo in primary careAdults with minor depression or dysthymia3303 mo, 25 wk76% recovery for minor depression, 68% for dysthymia at 3 mo; No group differences reported.
Richards et al, 200331RCTSelf-help intervention by practice nurses of up to 3 appointments vs usual careAdult patients presenting to their GP with mild to moderate anxiety/depression1391 and 3 moIntervention group patients were more likely to be below clinical threshold vs usual care group and were more satisfied
Seeley et al, 199632aSBATraining in detection and management of postnatal depression (use of counseling/CBT skills)HVs and postnatally depressed women46 HVs, number of patients unclear±No significant difference in change in mothers' experience of infant care. Rate of mother-baby relationship problems lower at follow-up in intervention group
Stewart-Brown et al, 200441RCT10-wk general practice-based parenting program by HVs vs wait-list controlParents of children aged 2-8 with behavior problems116 parentsImmediate, 6 and 12 moChildren's behavior improved significantly more than control children, both immediately and at 6-mo follow-up; No significant difference at 12 mo
  • RCT indicates randomized, controlled trial; GP, general practitioner; CBT, cognitive-behavioral therapy; SBA, simple before and after study; HV, health visitor.

  • a Studies are taken from Bower et al.24