Specialist treatment for persistent depression in secondary care: Sustained effects from a multicentre UK study at 24 and 36 months

Nixon, Neil; Guo, Boliang; Kaylor-Hughes, Catherine; Simpson, Sandra; Garland, Anne; Dalgleish, Tim; Morriss, Richard

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 HDRS17–2.69 (−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.

Citation

Nixon, N., Guo, B., Kaylor-Hughes, C., Simpson, S., Garland, A., Dalgleish, T., & Morriss, R. (2024). 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, 70-77. https://doi.org/10.1016/j.jad.2023.10.105

• Journal Article Type: Article
• Acceptance Date: Oct 15, 2023
• Online Publication Date: Oct 19, 2023
• Publication Date: Jan 15, 2024
• Deposit Date: Oct 27, 2023
• Publicly Available Date: Oct 31, 2023
• Journal: Journal of Affective Disorders
• Print ISSN: 0165-0327
• Electronic ISSN: 1573-2517
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 345
• Pages: 70-77
• DOI: https://doi.org/10.1016/j.jad.2023.10.105
• Keywords: Depression; Pragmatic; RCT; Collaborative; Long-term Outcomes
• Public URL: https://nottingham-repository.worktribe.com/output/26527636
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S016503272301296X?via%3Dihub