Abstract

BackgroundPersistent depressive symptoms below the threshold criteria for major depression represent a chronic condition with high risk of progression to a diagnosis of major depression. The evidence base for psychological treatments such as Person-Centred Counselling and Low-Intensity Cognitive Behavioural Therapy for sub-threshold depressive symptoms and mild depression is limited, particularly for longer-term outcomes.MethodsThis study aimed to test the feasibility of delivering a randomised controlled trial into the clinical and cost effectiveness of Low-Intensity Cognitive Behavioural Therapy versus Person-Centred Counselling for patients with persistent sub-threshold depressive symptoms and mild depression. The primary outcome measures for this pilot/feasibility trial were recruitment, adherence and retention rates at six months from baseline. An important secondary outcome measure was recovery from, or prevention of, depression at six months assessed via a structured clinical interview by an independent assessor blind to the participant’s treatment condition. Thirty-six patients were recruited in five general practices and were randomised to either eight weekly sessions of person-centred counselling each lasting up to an hour, or up to eight weeks of cognitive-behavioural self-help resources with guided telephone support sessions lasting 20–30 minutes each.ResultsRecruitment rate in relation to the number of patients approached at the general practices was 1.8 %. Patients attended an average of 5.5 sessions in both interventions. Retention rate for the 6-month follow-up assessments was 72.2 %. Of participants assessed at six months, 71.4 % of participants with a diagnosis of mild depression at baseline had recovered, while 66.7 % with a diagnosis of persistent subthreshold depression at baseline had not developed major depression. There were no significant differences between treatment groups for both recovery and prevention of depression at six months or on any of the outcome measures.ConclusionsIt is feasible to recruit participants and successfully deliver both interventions in a primary care setting to patients with subthreshold and mild depression; however recruiting requires significant input at the general practices. The evidence from this study suggests that short-term Person-Centred Counselling and Low-Intensity Cognitive Behaviour Therapy are potentially effective and their effectiveness should be evaluated in a larger randomised controlled study which includes a health economic evaluation.Trial registrationCurrent Controlled Trials ISRCTN60972025.

Highlights

  • Persistent depressive symptoms below the threshold criteria for major depression represent a chronic condition with high risk of progression to a diagnosis of major depression

  • Low-Intensity Cognitive Behavioural Therapy (Li-Cognitive behavioural therapy (CBT)), involving guided self-help CBT interventions, has been found to be an effective intervention for mild to moderate depression compared with no treatment controls, with a mean effect (Cohen’s d) of 0.8 [6]

  • The overall recruitment rate in relation to screening packs distributed in the general practice clinics was 36/ 1,964 = 1.83 %

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Summary

Introduction

Persistent depressive symptoms below the threshold criteria for major depression represent a chronic condition with high risk of progression to a diagnosis of major depression. The evidence base for psychological treatments such as Person-Centred Counselling and Low-Intensity Cognitive Behavioural Therapy for sub-threshold depressive symptoms and mild depression is limited, for longer-term outcomes. Having persistent depressive symptoms below the threshold criteria for major depression is a chronic and disabling condition with a high risk of progression [3, 4]. Low-Intensity Cognitive Behavioural Therapy (Li-CBT), involving guided self-help CBT interventions, has been found to be an effective intervention for mild to moderate depression compared with no treatment controls, with a mean effect (Cohen’s d) of 0.8 [6]. Guided self-help CBT, which is termed a low intensity (LI) intervention because the amount of practitioner time is limited compared to traditional high intensity (HI) expert-led treatments, can be delivered through books, classes, computers and online resources [7]. Expert delivered CBT and guided self-help CBT showed equivalent outcomes for depression in a recent meta-analysis of findings from randomised controlled trials [8]

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