Abstract
BackgroundA specialist depression service (SDS) offering collaborative pharmacological and cognitive behaviour therapy treatment for persistent depressive disorder showed effectiveness against depression symptoms versus usual community based multidisciplinary care in a randomised controlled trial (RCT) in specialist mental health services in England. However, there is uncertainty concerning how specialist depression services effect such change. The current study aimed to evaluate the factors which may explain the greater effectiveness of SDS compared to Treatment as Usual (TAU) by exploring the experience of the RCT participants.MethodsQualitative audiotaped and transcribed semi-structured interviews were conducted 12–18 months after baseline with 21 service users (12 SDS, 9 TAU arms) drawn from all three sites. Inductive thematic analysis using a grounded approach contrasted the experiences of SDS with TAU participants.ResultsFour themes emerged in relation to service user experience: 1. Specific treatment components of the SDS: which included sub-themes of the management of medication change, explaining and developing treatment strategies, setting realistic expectations, and person-centred and holistic approach; 2. Individual qualities of SDS clinicians; 3. Collaborative team context in SDS: which included sub-themes of communication between healthcare professionals, and continuity of team members; 4. Accessibility to SDS: which included sub-themes of flexibility of locations, frequent consultation as reinforcement, gradual pace of treatment, and challenges of returning to usual care.ConclusionsThe study uncovered important mechanisms and contextual factors in the SDS that service users experience as different from TAU, and which may explain the greater effectiveness of the SDS: the technical expertise of the healthcare professionals, personal qualities of clinicians, teamwork, gradual pace of care, accessibility and managing service transitions. Usual care in other specialist mental health services may share many of the features from the SDS.Trial registration“Trial of the Clinical and Cost Effectiveness of a Specialist Expert Mood Disorder Team for Refractory Unipolar Depressive Disorder” was registered in www.ClinicalTrials.gov (NCT01047124) on 12–01-2010 and the ISRCTN registry was registered in www.isrctn.com (ISRCTN10963342) on 25–11-2015 (retrospectively registered).
Highlights
A specialist depression service (SDS) offering collaborative pharmacological and cognitive behaviour therapy treatment for persistent depressive disorder showed effectiveness against depression symptoms versus usual community based multidisciplinary care in a randomised controlled trial (RCT) in specialist mental health services in England
Four main themes emerged from the data that related to service user experience: specific treatment components of the SDS; the individual qualities of clinicians; the collaborative team approach; and the accessibility of the SDS treatments
The transition into usual care was difficult for some participants to adjust to
Summary
A specialist depression service (SDS) offering collaborative pharmacological and cognitive behaviour therapy treatment for persistent depressive disorder showed effectiveness against depression symptoms versus usual community based multidisciplinary care in a randomised controlled trial (RCT) in specialist mental health services in England. Major depressive disorder is experienced by up to 15% of people in high income countries at least once in their lifetime [1]. Combined pharmacotherapy and psychological treatments delivered by specialist multi-professional teams are widely recommended [4] This collaborative care approach is characterised by joint assessments by psychiatrists and psychological therapists, and the development of structured management plans according to protocols for both psychotherapy and pharmacology based on NICE Guidelines for depression (2009) [5]. A large scale RCT of a Specialist Depression Service (SDS) providing pharmacotherapy and psychological treatment from a collaborative specialist team [7] showed a significant reduction in depression symptoms after 18 months [8]. There is uncertainty about the factors which may contribute to these improved outcomes for people experiencing severe and recurring depression [9] and service users’ experience of these
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