Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness

被引:199
|
作者
Ward, E
King, M [2 ]
Lloyd, M
Bower, P
Sibbald, B
Farrelly, S
Gabbay, M
Tarrier, N
Addington-Hall, J
机构
[1] Kings Coll London, Sch Med & Dent, Dept Palliat Care & Policy, London, England
[2] UCL, Royal Free & Univ Coll Med Sch, Dept Psychiat & Behav Sci, London NW3 2PF, England
[3] Univ Manchester, NPCRDC, Manchester M13 9PL, Lancs, England
[4] Univ Liverpool, Dept Primary Care, Liverpool L69 3BX, Merseyside, England
[5] Univ Manchester, Sch Psychiat & Behav Sci, Dept Clin Psychol, Manchester M13 9PL, Lancs, England
来源
BMJ-BRITISH MEDICAL JOURNAL | 2000年 / 321卷 / 7273期
关键词
D O I
10.1136/bmj.321.7273.1383
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To compare the clinical effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients. Design Prospective, controlled trial with randomised and patient preference allocation arms. Setting General practices in London and greater Manchester. Participants 464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion. Interventions Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists. Main outcome measures Beck depression inventory scores, other psychiatric symptoms, social functioning, and satisfaction with treatment measured at baseline and at 4 and 12 months. Results 197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. All groups improved significantly over time. At four months, patients randomised to non-directive counselling or cognitive-behaviour therapy improved more in terms of the Beck depression inventory (mean (SD) scores 12.9 (9.3) and 14.3 (10.8) respectively) than those randomised to usual general practitioner care (18.3 (12.4)). However, there was no significant difference between the two therapies. There were no significant differences between the three treatment groups at 12 months (Beck depression scores 11.8 (9.6), 11.4 (10.8), and 12.1(10.3) for non-directive counselling, cognitive-behaviour therapy, and general practitioner care). Conclusions Psychological therapy was a more effective treatment for depression than usual general practitioner care in the short term, but after one year there was no difference in outcome.
引用
收藏
页码:1383 / 1388
页数:6
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