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Specialist treatment for persistent depression in secondary care: Sustained effects from a multicentre UK study at 24 and 36 months
Abstract
BACKGROUND: Despite the known health costs of persistent depression, there is no established service framework for the treatment of this disorder and a lack of long-term outcome data to inform commissioning. To address this gap, we report the long-term clinical effectiveness of a randomised controlled trial (RCT) testing a specialist, collaborative model of care for people with persistent moderate to severe unipolar depression. METHODS: A multicentre, pragmatic, single-blind, parallel-group randomised controlled trial comparing outcomes from a Specialist Depression Service (SDS) offering collaborative treatment with cognitive behavioural therapy (CBT) and pharmacotherapy for 12 months with treatment as usual (TAU) for persistent, moderate-severe depression in UK secondary care. Participants were initially assessed at baseline, 3, 6, 9, 12, and 18 months, with primary endpoints (17-item Hamilton Depression Rating Scale [HDRS17], and a Global Assessment of Functioning [GAF]) reported elsewhere (Morriss et al., 2016). Additional long-term, post-treatment, follow-up was made at 24 and 36 months with outcomes presented here. CLINICALTRIALS: gov (NCT01047124) and ISRCTN registration (ISRCTN 10963342). RESULTS: At 24 months there remained a statistically significant between-group difference in HDRS(17)-2.69 (-5.14, -0.23) and a non-significant improvement in GAF 2.85 (-1.23, 6.94), both favouring the SDS. Simple statistics are presented at 36 months, due to attrition, showing higher continued response and remission vs TAU across all measures. LIMITATIONS: Potential bias through loss to follow-up, particularly beyond 24 months. CONCLUSIONS: Compared with standard secondary care, SDS management of persistent moderate-severe depression, produced long-term clinical benefits, sustained following treatment completion, suggesting a model for future specialist care.
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Date
2023
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Article
Subject
Depression, Long-term care
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Nixon, N., Guo, B., Kaylor-Hughes, C., Simpson, S., Garland, A., Dalgleish, T. & Morriss, R. (2023). Specialist treatment for persistent depression in secondary care: Sustained effects from a multicentre UK study at 24 and 36 months. Journal of Affective Disorders, 345, pp.70-77.
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© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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