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CASCADE: Case finding for depression in primary care: a regression discontinuity design

About a quarter of older people are depressed. Most do not receive help from the NHS.  We wanted to know if screening older people for depression to get them the help they need – would reduce their symptoms of depression after six months.  

Why did we do this research?

We wanted to know if screening older people for depression to get them the help they need – would reduce their symptoms of depression after six months.  

What did we do?

We contacted 15849 participants from 15 GP practices in the North of England.  1020 people agreed to take part and complete a questionnaire.  If a patient’s response suggested they might be depressed, we let them and their GP know, so they could take action. Six months later patients completed another questionnaire.  We checked if patient’s symptoms of depression had decreased. We interviewed patients, doctors and nurses to find out what they thought about screening and what actions they took based on the screening results.  

Who was involved?

1020 participants were recruited from 15 GP practices from the North of England.

What did we find?

There was a very small decrease in patient's depression scores after 6 months for patients who had depressive symptoms. This wasn't enough to say that screening was helpful. The additional cost of screening would not be good value for the NHS.
The interviews revealed that participants thought the study might help people talk to their GP about feeling depressed. Some patients did not get the support they wanted from their GP. Patients thought it would be a good idea to keep sending out the questionnaire after the study had finished.  Doctors and nurses who helped organise the study were not sure about this. They said they might not have the time and money. There were also concerns that very depressed people may not complete the form. 
We believe that it is unlikely that the screening method used in our study will help people with depression feel better after six months.  

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Department of Health Sciences, University of York, York

  • Professor David Ekers – Visiting Professor at the University of York, and Mental Health Speciality Lead for the Clinical Research Network in the North East and North Cumbria