Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial

Objectives To determine the acceptability of two psychological intervention s for depressed adults in the community and their effect on caseness, sympt oms, and subjective function. Design A pragmatic multicentre randomised controlled trial, stratified by c entre. Setting Nine urban and rural communities in Finland, Republic of Ireland, N orway, Spain, and the United Kingdom. Participants 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the internatio nal classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Interventions Six individual sessions of problem solving treatment (n = 128 ), eight group sessions of the course on prevention of depression (n = 108) , and controls (n = 189). Main outcome measures Completion rates for each intervention, diagnosis of depression. and depressive symptoms and subjective function. Results 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of p roblem solving participants depressed at six months was 17% less than that fur controls, giving a number needed to treat of 6: the mean difference in Beck depression inventory score was -2.63 (95% interval -4.95 to -0.32), an d there were significant improvements in SF-36 scores. For depression preve ntion, die difference in proportions of depressed participants was 14% (num ber needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements i n SF-36 scores. Such differences were not observed at 12 months. Neither sp ecific diagnosis nor treatment with antidepressants affected outcome. Conclusions When offered to adults with depressive disorders in the communi ty, problem solving treatment was more acceptable than the course on preven tion of depression. Both interventions reduced caseness and improved subjec tive function..