Abstract
BackgroundDepression is a common illness with great human costs and a significant burden on the public economy. Previous studies have indicated that collaborative care (CC) has a positive effect on symptoms when provided to people with depression, but CC has not yet been applied in a Danish context. We therefore developed a model for CC (the Collabri model) to treat people with depression in general practice in Denmark. Since systematic identification of patients is an “active ingredient” in CC and some literature suggests case finding as the best alternative to standard detection, the two detection methods are examined as part of the study. The aim is to investigate if treatment according to the Collabri model has an effect on depression symptoms when provided to people with depression in general practice in Denmark, and to examine if case finding is a better method to detect depression in general practice than standard detection.Methods/DesignThe trial is a cluster-randomised, clinical superiority trial investigating the effect of treatment according to the Collabri model for CC, compared to treatment as usual for 480 participants diagnosed with depression in general practice in the Capital Region of Denmark. The primary outcome is depression symptoms (Beck’s Depression Inventory (BDI-II)) after 6 months. Secondary outcomes include depression symptoms (BDI-II) after 15 months, anxiety symptoms (Beck’s Anxiety Inventory (BAI)), level of functioning (Global Assessment of Function (GAF)) and psychological stress (Symptom Checklist-90-Revised (SCL-90-R)). In addition, case finding (with the recommended screening tool Major Depression Inventory (MDI)) and standard detection of depression is examined in a cluster-randomized controlled design. Here, the primary outcome is the positive predictive value of referral diagnosis.DiscussionIf the Collabri model is shown to be superior to treatment as usual, the study will contribute with important knowledge on how to improve treatment of depression in general practice, with major benefit to patients and society. If case finding is shown to be superior to standard detection, it will be recommended as the detection method in future treatment according to the Collabri model.Trial registrationClinicalTrials.gov. NCT02678845. Retrospectively registered on 7 February 2016.
Highlights
Depression is a common illness with great human costs and a significant burden on the public economy
In the reviewed randomized controlled trials (RCTs), screening was conducted using a variety of other tools including the General Health Questionnaire (GHQ), Patient Health Questionnaire (PHQ)-9, Primary Care Evaluation of Mental Disorders (PRIME-Mean difference (MD)), and hospital anxiety and depression scale (HADS), but we planned to use the Major Depression Inventory (MDI), a self-assessment questionnaire that uses the diagnostic criteria from International Classification of Diseases edition 10 (ICD-10) [19] and is recommended for screening and diagnostics of depression in Denmark [1]
Individual level Patients are eligible for the outcome study and the detection of depression study if their General practitioner (GP) participates in the study and the patient complies with the following inclusion and exclusion criteria, assessed either by the GP at recruitment and/or by a research assistant at a baseline eligibility interview
Summary
Depression is a common illness with great human costs and a significant burden on the public economy. We developed a model for CC (the Collabri model) to treat people with depression in general practice in Denmark. The aim is to investigate if treatment according to the Collabri model has an effect on depression symptoms when provided to people with depression in general practice in Denmark, and to examine if case finding is a better method to detect depression in general practice than standard detection. The human cost relating to depression is great, but the illness places a significant burden on the public economy. There is a shortage of independent psychiatrists and psychologists trained in CBT or other evidence-based psychotherapies targeting depression, delaying the specialised treatment of patients referred from general practice [6]
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