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Matching depression management to severity prognosis in primary care: results of the target-D randomised controlled trial

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journal contribution
posted on 01.02.2021, 00:00 authored by S Fletcher, P Chondros, K Densley, E Murray, C Dowrick, A Coe, K Hegarty, S Davidson, C Wachtler, Cathy Mihalopoulos, Yong Yi Lee, Mary Lou Chatterton, V J Palmer, J Gunn
Background Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required.

Aim To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care.

Design and setting Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18–65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care.

Method The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months.

Results In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was −0.88 (95% confidence interval [CI] = −1.45 to −0.31) favouring the intervention, and −0.59 at 12 months (95% CI = −1.18 to 0.01); standardised effect sizes of −0.16 (95% CI = −0.26 to −0.05) and −0.10 (95% CI = −0.21 to 0.002), respectively. No serious adverse events were reported.

Conclusion Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.

History

Journal

British journal of general practice

Volume

71

Issue

703

Pagination

E85 - E94

Publisher

Royal College of General Practitioners

Location

London, Eng.

ISSN

0960-1643

eISSN

1478-5242

Language

eng

Publication classification

C1 Refereed article in a scholarly journal