Accessibility statement


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

Depression is the most common mental health disorder amongst the older population. However, GPs face difficulties in identifying depressed older patients. This may be because symptoms coexist with those of other comorbidities, or that symptoms of depression in older adults can be different from those exhibited by younger adults. Whilst the United States recommends screening for depression in the general adult population, routine screening is not currently recommended in the UK. Currently, there is little evidence that routine case findings, or screening, of older adults with depression, is effective and cost-effective at reducing depressive symptoms.

We have previously used a novel evaluative design – the regression discontinuity design – to show that screening for depression and informing the GPs of patients with symptoms indicative of severe depression could reduce symptom severity after 6 months. The CASCADE study aims to replicate our previous work within a larger sample of older people, mailing out the Geriatric Depression Scale to 10,000 patients aged 65 and over in the North of England. For those who score 5 points or more, we will write to the participant and their GP reporting the result. We will follow all participants up after six months. We will also include qualitative and survey data to describe the treatments that participants received and undertake a full cost-utility analysis.

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National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR203506).

Start Date: September 2021
End Date: September 2023


YTU Team

External Members

  • 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

Contact Us

For further information on CASCADE please contact:


If you would like to talk to someone about your physical or mental health there are many different ways you can access information and support.


Can provide advice and support to empower people experiencing mental health problems. Phone: 0300 123 3393. 9am to 6pm, Monday to Friday (except for bank holidays).


Can connect you to the health information and services that you may need. Phone: 111, or contact your GP.

Age UK

Provide services and support at a national and local level to inspire, enable and support older people. Phone: 0800 678 1602. Open 24 hours a day, 7 days a week.

Mental Health Foundation

Work to help people understand, protect and sustain their mental health.

Silver Line

A confidential, free helpline designed for older people. The helpline offers information, signposting, advice, and a place to talk. Phone: 0800 4 70 80 90. Open 24 hours a day, 7 days a week.


For anyone who is struggling to cope, who needs someone to listen without judgement or pressure. Phone: 116 123. Open 24 hours a day, 7 days a week.

If you have been sent a text message or email from your GP about this study and you are interested in taking part, please find more information linked below. CASCADE: Taking Part