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Cited by 489Mental Health Treatment and AccessClinical practice guidelines implementationAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial

Thompson, C, Kinmonth, AL, Stevens, L, Pevele, RC, Stevens, A, Ostler, KJ, Pickering, RM, Baker, NG +4 more·2000·The Lancet
DOI 10.1016/s0140-6736(99)03171-2
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Abstract

Background Depression is a major individual and public-health burden throughout the world and is managed mainly in primary care. The most effective strategy to reduce this burden has been believed to be education of primary-care practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in improving the recognition and outcome of primary-care depression.Methods We carried out a randomised controlled trial in a representative sample of 60 primary-care practices (26% of the total) in an English health district. Education was delivered to practice teams and quality tested by feedback from participants and expert raters. The primary endpoints were recognition of depression, defined by the hospital anxiety and depression (HAD) scale, and clinical improvement. Analysis was by intention to treat.Findings The education was well received by participants, 80% of whom thought it would change their management of patients with depression. 21409 patients were screened, of whom 4192 were classified as depressed by the HAD scale. The sensitivity of physicians to depressive symptoms was 39% in the intervention group and 36% in the control group after education (odds ratio 1.2 [95% CI 0.88-1.61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly improve.Interpretation Although well received, this in-practice programme, which was designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery from depression.

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  • Even if patients consult their GP, mental health problems may not always be detected.

    “Even if patients do consult their GP, problems may not always be detected.Shortcomings in clinicians' skills in detecting mental health problems have been commonly reported.1,8”

    From Can a self-referral system help improve access to psychological treatments? (2010) · cites this paper as [8]

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Authors
Thompson, C., Kinmonth, A., Stevens, L., Pevele, R., Stevens, A., Ostler, K., Pickering, R., Baker, N., Henson, A., Preece, J., Cooper, D., & Campbell, M.
Affiliations
  • Royal South Hants Hospital (GB)
  • University of Cambridge (GB)
  • University of Birmingham (GB)
  • University of Southampton (GB)
Corresponding author
Thompson, C
ORCID
Stevens, A
Venue
The Lancet
Publisher
Elsevier BV
Published
2000-01
Volume
355
Issue
9199
Pages
185-191
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(99)03171-2
OpenAlex
W2171125113
Cited by
489
References
32
Citations by year
2025: 2 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 7 · 2018: 7 · 2017: 9 · 2016: 13 · 2015: 9 · 2014: 17 · 2013: 22 · 2012: 15
FWCI
76.81
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, primary care, practice-based education, physician training, depression detection, screening, Hospital Anxiety and Depression Scale, clinical outcomes
MeSH terms
Antidepressive Agents, Tricyclic, Depression, Education, Medical, Continuing, England, Humans, Physicians, Family, Program Evaluation, Logistic Models, Practice Guidelines as Topic

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