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Randomized Controlled Trial
. 2021 Jan 28;71(703):e85-e94.
doi: 10.3399/BJGP.2020.0783. Print 2021.

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

Susan Fletcher  1 , Patty Chondros  1 , Konstancja Densley  1 , Elizabeth Murray  2 , Christopher Dowrick  3 , Amy Coe  1 , Kelsey Hegarty  4 , Sandra Davidson  1 , Caroline Wachtler  5 , Cathrine Mihalopoulos  6 , Yong Yi Lee  7 , Mary Lou Chatterton  6 , Victoria J Palmer  1 , Jane Gunn  8
Affiliations
Randomized Controlled Trial

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

Susan Fletcher et al. Br J Gen Pract. .

Abstract

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.

Keywords: clinical prediction rule; general practice; mental health; primary health care; randomised controlled trial.

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Figures

Figure 1.
Figure 1.
Participant flow through the trial. Denominators used to calculate the percentage with follow-up at 3- and 12-months are the total number of participants randomised overall and within each prognostic group. None of the withdrawals requested that their data be withdrawn prior to the statistical analysis. CPT = clinical prediction tool. ITT = intention to treat.
Figure 2.
Figure 2.
Estimated mean depressive symptom severity (9-item Patient Health Questionnaire) with 95% confidence intervals for each trial arm, in total and by prognostic group and time-point.
See this image and copyright information in PMC

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References

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