SECONDARY PREVENTION OF RELAPSE IN DEPRESSION

The clinical and cost-effectiveness of low-intensity psychological interventions for the secondary prevention of relapse after depression: a systematic review and decision analytical model

Background

Depression is a common condition defined by persistent depressed mood and loss of interest in activities. Even after successful treatment, a high proportion of people will go on to have a relapse of their depression. People with depression may be treated with medicines, psychological interventions or both. Psychological interventions can be classed as 'high-intensity' or 'low-intensity' depending upon the amount of direct contact between the patient and a health professional. Low-intensity psychological interventions can include approaches such as computer-delivered treatments and self-help books, for which people may or may not receive personal support.

The aim of this project was to determine the clinical effectiveness and cost-effectiveness of low intensity psychological interventions in preventing relapse of depression.

Findings

There is inadequate evidence to determine the clinical effectiveness or cost-effectiveness of low-intensity interventions for the prevention of relapse or recurrence of depression. A scoping review of brief high-intensity therapies indicates that some approaches (e.g. MBCT in a group setting) have shown promise in some studies, but findings have not been consistent.

There is a need for further primary research, and careful consideration should be given to the scope of such research to inform this issue. It is important to evaluate the broader patient pathway accounting for the heterogeneous patient groups of interest.

Future RCTs should be conducted in a UK primary care setting and include adult participants in remission or recovery from depression. They should evaluate the quality of the intervention and consistency of delivery across practitioners where appropriate. The occurrence of relapse or recurrence should be measured using established methods, and functional outcomes as well as symptoms should be measured; data on QoL using a generic instrument, such as the EQ-5D, should be collected.

Conducted by: CRD and the Centre for Health Economics, University of York

Further details

Project page on NIHR HTA Programme website

Publications

Rodgers M, Asaria M, Walker S, McMillan D, Lucock M, Harden M, Palmer S, Eastwood A. The clinical effectiveness and cost-effectiveness of low-intensity psychological interventions for the secondary prevention of relapse after depression: a systematic review. Health Technol Assess 2012;16(28):1-130

Funding

Commissioned by the NIHR HTA Programme as part of the Technology Assessment Report (TAR) process