Acceptability of a guided self-help mental health intervention in general practice.

BACKGROUND: People with subthreshold mental health syndromes are common in general practice and represent an important morbidity and disability burden. Management options are currently limited. We examined the acceptability of a novel ultra-brief guided self-help intervention designed specifically for use in this setting. OBJECTIVE: To assess clinician and patient satisfaction with an ultra-brief guided self-help intervention to address subthreshold mental health syndromes in the primary care setting. METHODS: Consenting patients were given the ultra-brief intervention in a series of three 15- to 30-minute coaching sessions over a 5-week period. DESIGN: survey interview of clinician and patient satisfaction with and acceptability of the intervention. SETTING: general practices in Wellington, New Zealand. MAIN OUTCOME MEASURE: clinician and patient acceptability of the intervention was assessed by survey questionnaire at 3 months. Baseline and follow-up mental health status assessments were undertaken using the Kessler-10 measure of psychological distress. RESULTS: Six clinicians recruited 19 patient participants, 16 of whom completed the intervention. Based on questionnaire feedback, clinician and patient satisfaction ratings were very positive. However, clinicians expressed a concern that the length of the sessions was sometimes inadequate. The psychological well-being of the patients, as measured by the Kessler-10, was also significantly improved post-intervention. CONCLUSION: The intervention appeared to improve the psychological well-being of the patients and was regarded positively by both clinicians and patient participants. Further testing of the efficacy of the intervention on a larger sample with a randomized controlled trial study design is warranted.

Depression in adults: drug and physical treatments.

INTRODUCTION: Depression may affect up to 10% of the population, with half of affected people having recurrence of their symptoms. In mild to moderate depression, there is no reliable evidence that any one treatment is superior in improving symptoms of depression, but the strength of evidence supporting different treatments varies. In severe depression, only prescription antidepressants and electroconvulsive therapy are known to improve symptoms. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in mild to moderate and severe depression, and in treatment-resistant depression? Which interventions reduce relapse rates? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 88 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antidepressant drugs (tricyclic antidepressants [including low-dose tricyclic antidepressants], selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, or venlafaxine), continuing prescription antidepressant drugs, electroconvulsive therapy, exercise, lithium augmentation, pindolol augmentation, and St John's wort.