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Social intervention for British Pakistani women with depression: randomised controlled trial

  • Richard Gater (a1), Waquas Waheed (a2), Nusrat Husain (a2), Barbara Tomenson (a2), Saadia Aseem (a2) and Francis Creed (a3)...
Extract
Background

British Pakistani women have a high prevalence of depression. There are no reported psychosocial interventions for depression in ethnic minorities in the UK.

Aims

To determine the efficacy of a social group intervention compared with antidepressants, and whether the combination of the two is more efficacious than either alone.

Method

A total of 123 women with depression participated in the primary care-based cluster randomised controlled trial (ISRCTN19172148). Outcome measures were severity of depression (Hamilton Rating Scale for Depression), social functioning and satisfaction at 3 and 9 months.

Results

Greater improvement in depression in the social intervention group and the combined treatment group compared with those receiving antidepressants alone fell short of significance. There was significantly greater improvement in social functioning in the social intervention and combined treatment groups than in the antidepressant group at both 3 and 9 months.

Conclusions

Pakistani women with depression found the social groups acceptable and their social function and satisfaction improved if they received social treatment compared with the receipt of antidepressants alone.

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Copyright
Corresponding author
N. Husain, Psychiatry Research Group, Third Floor University Place, Oxford Road, Manchester M13 9PL, UK. Email: nusrat.husain@manchester.ac.uk
Footnotes
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See editorial, pp. 172–173, this issue.

Declaration of interest

W.W. has received a research grant from Servier and support for educational, travel support and/or speaker fees from AstraZeneca, Eli Lilly, Sanofi-Aventis, Bristol-Myers Squibb, Janssen Cilag and Wyeth. N.H. has received support for educational programmes, travel support and/or speaker fees from AstraZeneca, Eli Lilly, Lundbeck, Sanofi-Aventis, Bristol- Myers Squibb, Janssen Cilag and Wyeth. F.C. has received speaker fees from Eli Lilly.

Footnotes
References
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1 Gater, R, Tomenson, B, Percival, C, Chaudhry, N, Waheed, W, Dunn, G, et al. Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in UK. Soc Psychiatry Psychiatr Epidemiol 2009; 44: 198207.
2 Husain, N, Creed, F, Tomenson, B. Adverse social circumstances and depression in people of Pakistani origin in the UK. Br J Psychiatry 1997; 171: 434–8.
3 Weich, S, Nazroo, J, Sproston, K, McManus, S, Blanchard, M, Erens, B, et al. Common mental disorders and ethnicity in England: the EMPIRIC study. Psychol Med 2004; 8: 1543–51.
4 Bhui, K, Bhugra, D, Goldberg, D, Dunn, G, Desai, M. Cultural influences on the prevalence of common mental disorder, general practitioners' assessments and help-seeking among Punjabi and English people visiting their general practitioner. Psychol Med 2001; 31: 815–25.
5 McKenzie, K, Bhui, K, Nanchahal, K, Blizard, B. Suicide rates in people of South Asian origin in England and Wales: 1993–2003. Br J Psychiatry 2008; 193: 406–9.
6 Cooper, J, Husain, N, Webb, R, Waheed, W, Kapur, N, Guthrie, E, et al. Self-harm in the UK: differences between South Asians and Whites in rates, characteristics, provision of service and repetition. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 782–8.
7 Khan, F, Waheed, W. Suicide and self-harm in South Asian immigrants. Psychiatry 2009; 8: 261–4.
8 Commander, MJ, Odell, SM, Surtees, PG, Sashidharan, SP. Care pathways for south Asian and white people with depressive and anxiety disorders in the community. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 259–64.
9 Cornwell, J, Hull, S. Do GPs prescribe antidepressants differently for South Asian patients? Fam Pract 1998; 15: S168.
10 Hull, SA, Aquino, P, Cotter, S. Explaining variation in antidepressant prescribing rates in east London: a cross sectional study. Fam Pract 2005; 22: 3742.
11 Bhugra, D, Baldwin, D, Desai, M. A pilot study of the impact of fact sheets and guided discussion on knowledge and attitudes regarding depression in an ethnic minority sample. Prim Care Psychiat 1997; 3: 135–40.
12 Jacob, KS, Bhugra, D, Mann, AH. A randomised controlled trial of an educational intervention for depression among Asian women in primary care in the United Kingdom. Int J Soc Psychiatry 2002; 48: 139–48.
13 Bhugra, D, Hicks, MH. Effect of an educational pamphlet on help-seeking attitudes for depression among British South Asian women. Psychiatr Serv 2004; 55: 827–9.
14 Campbell, M, Fitzpatrick, R, Haines, A, Kinmonth, AL, Sandercock, P, Spiegelhalter, D, et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000; 321: 694–6.
15 Chaudhry, N, Waheed, W, Husain, N, Hijazi, S, Creed, F. Development and pilot testing of a social intervention for depressed women of Pakistani family origin in the UK. J Ment Health 2009; 18: 504–9.
16 World Health Organisation. A User's Guide to the Self-reporting Questionnaire (SRQ). Division of Mental Health, WHO, 1994.
17 Husain, N, Gater, R, Tomenson, B, Creed, F. Comparison of the Personal Health Questionnaire and the Self Reporting Questionnaire in rural Pakistan. J Pak Med Assoc 2006; 56: 366–70.
18 Lewis, G, Pelosi, AJ, Araya, R, Dunn, G. Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 1992; 22: 465–86.
19 National Institute for Health and Clinical Excellence. Depression: Management of Depression in Primary and Secondary Care (Clinical Guideline 23). NICE, 2004.
20 Hamilton, M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6: 278–96.
21 Bolton, P, Tang, AM. An alternative approach to cross-cultural function assessment. Soc Psychiatry Psychiatr Epidemiol 2002; 37: 537–43.
22 Ruggeri, M, Dall'Agnola, R. The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals. Psychol Med 1993; 23: 511–23.
23 Rahman, A, Iqbal, Z, Waheed, W, Hussain, N. Translation and cultural adaptation of health questionnaires. J Pak Med Assoc 2003; 53: 142–7.
24 Campbell, MK, Elbourne, DR, Altman, DG. CONSORT statement: extension to cluster randomised trials. BMJ 2004; 328: 702–8.
25 Dunn, G, Maracy, M, Dowrick, C, Ayuso-Mateos, JL, Dalgard, OS, Page, H, et al. Estimating psychological treatment effects from a randomised controlled trial with both non-compliance and loss to follow-up. Br J Psychiatry 2003; 183: 323–31.
26 Miranda, J, Duan, N, Sherbourne, C, Schoenbaum, M, Lagomasino, I, Jackson-Triche, M, et al. Improving care for minorities: can quality improvement interventions improve care and outcomes for depressed minorities? Results of a randomized, controlled trial. Health Serv Res 2003; 38: 613–30.
27 Miranda, J, Chung, JY, Green, BL, Krupnick, J, Siddique, J, Revicki, DA, et al. Treating depression in predominantly low-income young minority women – a randomized controlled trial. JAMA 2003; 290: 5765.
28 Keller, MB. Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. JAMA 2003; 289: 3152–60.
29 Yonkers, KA, Samson, J. Mood disorders measures. In Handbook of Psychiatric Measures (eds AJ Rush, HA Pincus, MB First, D Blacker): 515–48. American Psychiatric Association, 2000.
30 Ronalds, C, Creed, F, Stone, K, Webb, S, Tomenson, B. Outcome of anxiety and depressive disorders in primary care. Br J Psychiatry 1997; 171: 427–33.
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Social intervention for British Pakistani women with depression: randomised controlled trial

  • Richard Gater (a1), Waquas Waheed (a2), Nusrat Husain (a2), Barbara Tomenson (a2), Saadia Aseem (a2) and Francis Creed (a3)...
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eLetters

Antidepressant or Treatment as usual?

Johanna Brown, CT2 Psychiatry Trainee
06 October 2010

Antidepressant or Treatment as usual?

The study by Gater et al. aimed to determine how effective social group intervention would be in British Pakistani women with depression in comparison to antidepressant treatment(1). As noted by Gater et al. depression in ethnic minority populations is a complex issue and they haveaddressed an important aspect of treatment provision in this population. There are however, some points that we would like to raise.

Gater et al. established three intervention groups: social intervention, antidepressant intervention and combined intervention. As this was a cluster randomised trial it was important that the groups be homogenous in order that they are comparable when they are allocated to interventions(2). The interventions were applied at the cluster level. However, when looking closely at the groups and the allocation of each intervention it appears that these allocations were not assigned firmly. As noted in the paper, the numbers of participants on the “antidepressant intervention” were 54% at 3 months and 26% at 9 months. In addition, the “social intervention” group were also noted to be using antidepressants. In fact 18% of this group were on antidepressants at both 3 months and 9 months. Therefore, the differences in outcomes cannot be attributed to the named interventions.

It is worth highlighting then that the title of the antidepressant intervention group appears to be a misnomer. The authors provided GPs with NICE guidelines for management of depression and so it would have been more appropriate to call them the “treatment as usual” group(3). Consequently, On the assumption that GPs were referring to the protocol form the NICE Guidelines then they would be recommending other interventions before considering antidepressants. It is then difficult for the conclusions of the paper to hold true since the intervention groups did not hold true. Consequently, the authors’ comparison of their own paper with that of Miranda et al. is not a fair comparison since theirinterventions are not analogous(4).

The paper uses a small sample size for the intervention groups and does clearly explain the power calculations involved. However, the CONSORT guidelines recommend a specific cluster randomisation trial power calculation which the authors chose not to use(2). It is unclear why thiswas done given that they go on to highlight their use of the CONSORT guidelines for cluster randomisation trials in the section on statistical methods.

The paper lists their registration number as ISRCTN19172148 which allows readers to consider the original outcomes listed(5). When looking at these the primary outcome remained unchanged but the secondary outcomesare different to those listed in the paper. This is suggestive of some kind of selective reporting of outcome which is becoming a more widely recognised problem in trials(6).

In our opinion the appropriate conclusion would be that in Pakistani women with depression, social intervention led to more improvement in their social function and satisfaction than in treatment as usual alone.

References

(1) Gater R, Waheed W, Husain N, Tomenson B, Aseem S, Creed F. Social intervention for British Pakistani women with depression: randomised controlled trial; British Journal of Psychiatry 2010; 197, 227-233.

(2) Campbell MK, Elbourne DR, Altman DG. CONSORT statement: extensionto cluster randomised trials; British Medical Journal 2004; 328; 702-708.

(3) National Institute for Health and Clinical Excellence; Depression: Management of depression in Primary and Secondary Care (Clinical Guideline 23) NICE 2004.

(4) Miranda J, Chung JY, Green BL, Krunick J, Siddique J, Revicki DA,et al. Treating depression in predominantly low-income young minority women – a randomised controlled trial; Journal of the American Medical Association 2003; 289: 3152-60.

(5) http://www.controlled-trials.com/ISRCTN19172148; Accessed 26/09/10 at 20.26hrs.

(6) Kirkham JJ, Dwan KM, Altman DG, Gamble C, Dodd S, Smyth R, Williamson PR. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews; British Medical Journal 2010; 340:c365.
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Conflict of interest: None Declared

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