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A. I. F. Scott & C. P. L. Freeman's “Edinburgh Primary Care Depression Study”

  • J. Scott (a1), C. A. L. Moon (a2), C. V. R. Blacker (a3) and J. M. Thomas (a4)

Abstract

“Objective - To compare the clinical efficacy, patient satisfaction, and cost of three specialist treatments for depressive illness with routine care by general practitioners in primary care. Design - Prospective, randomised allocation to amitriptyline prescribed by a psychiatrist, cognitive behaviour therapy from a clinical psychologist, counselling and case work by a social worker, or routine care by a general practitioner. Subjects and setting - 121 patients aged between 18 and 65 years suffering depressive illness (without psychotic features) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition for major depressive episode in 14 primary care practices in southern Edinburgh. Main outcome measures - Standard observer rating of depression at outset and after four and 16 weeks. Numbers of patients recovered at four and 16 weeks. Total length and cost of therapist contact. Structured evaluation of treatment by patients at 16 weeks. Results - Marked improvement in depressive symptoms occurred in all treatment groups over 16 weeks. Any clinical advantage of specialist treatments over routine general practitioner care were small, but specialist treatment involved at least four times as much therapist contact and cost at least twice as much as routine general practitioner care. Psychological treatments, especially social work counselling, were most positively evaluated by patients. Conclusions - The additional costs associated with specialist treatments of new episodes of mild to moderate depressive illness presenting in primary care were not commensurate with their clinical superiority over routine general practitioner care. A proper cost-benefit analysis requires information about the ability of specialist treatment to prevent future episodes of depression.”

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References

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Blackburn, I., Bishop, S., Glenn, A., et al (1981) The efficacy of cognitive therapy in depression. British Journal of Psychiatry, 139, 181189.
Blackburn, I., Eunson, K. & Bishop, S. (1986) A two-year naturalistic follow-up of depressed patients with cognitive therapy, pharmacotherapy and combination of both. Journal of Affective Disorders, 10, 6775.
Blashki, T. G., Mowbray, R. & Davies, B. (1971) Controlled trial of amitriptyline in general practice. British Medical Journal, i, 133138.
Corney, R. (1984) The effectiveness of attached social workers in the management of depressed female patients in general practice. Psychological Medicine (suppl. 6).
Johnston, D. (1981) Depression: treatment compliance in general practice. Acta Psychiatrica Scandinavica (suppl. 63), 447453.
McLean, P. & Hakstian, A. (1979) Clinical depression: comparative efficacy of outpatient treatment. Journal of Consulting and Clinical Psychology, 47, 818836.
Paykel, E. S., Hollyman, J. A., Freeling, P., et al (1988) Predictors of therapeutic benefit from amitriptyline in mild depression; a general practice placebo controlled trial. Journal of Affective Disorders, 14, 8395.
Ross, S. & Scott, M. (1985) An evaluation of the effectiveness of individual and group cognitive therapy in the treatment of depressed patients in an inner city health centre. Journal of the Royal College of General Practitioners, 35, 239242.
Scott, A. I. F. & Freeman, C. P. L. (1992) Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks. British Medical Journal, 304, 883887.
Scott, J. (1994) Cognitive behaviour therapy in primary care. In Psychiatry and General Practice Today (eds I. Pullen, G. Wilkinson, D. P. Gray & A. Wright), pp. 294310. London: Gaskell.
Scott, J., Eccleston, D. & Boys, R. (1992) Can we predict the persistence of depression? British Journal of Psychiatry, 161, 633637.
Teasdale, J., Fennell, M., Hibbert, G., et al (1984) Cognitive therapy for major depression in primary care. British Journal of Psychiatry, 144, 400406.
Thompson, C. & Thompson, C. M. (1989) The prescribing of antidepressants in general practice. Human Psychopharmacology, 4, 191204.
Twaddle, V. & Scott, J. (1991) Cognitive theory and therapy of depression. In Adult Clinical Problems: A Cognitive Behavioural Approach (eds W. Dryden & R. Rentoul), pp. 5685. London: Routledge.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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A. I. F. Scott & C. P. L. Freeman's “Edinburgh Primary Care Depression Study”

  • J. Scott (a1), C. A. L. Moon (a2), C. V. R. Blacker (a3) and J. M. Thomas (a4)
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