Additional file 2: of Feasibility of training practice nurses to deliver a psychosocial intervention within a collaborative care framework for people with depression and long-term conditions

Summary of change in depression symptom level and service use. Tabulated data of average PHQ-9 scores per practice (baseline and post-treatment) and average number of contacts and related costs per practice and patient. (PDF 63 kb

Behavioural Activation vs. control effect size and subgroup analysis^a.

<p>Abbreviations: Standardised Mean Difference SMD (g): Confidence Interval CI; Numbers Needed to Treat NNT, Treatment as Usual TAU,</p>a<p>Hedges g, ^b p values in this column indicate if Q statistic is significant (I² does not provide test of significance).</p><p>*p<0.10.</p><p>** p<0.05.</p><p>*** p<0.005.</p><p>****p<0.0005.</p

Study quality assessment.

<p>Q1: Adequate generation of randomisation sequence; Q2: Allocation concealment; Q3: Blinding of assessment; Q4: dealing with missing data.</p

Behavioural Activation vs. control post treatment (ordered by effect size high to low).

<p>Behavioural Activation vs. control post treatment (ordered by effect size high to low).</p

Flowchart of study inclusion.

<p>Flowchart of study inclusion.</p

Properties of included studies.

<p>Properties of included studies.</p

Behavioural Activation vs. Antidepressant medication.

<p>Behavioural Activation vs. Antidepressant medication.</p

Cost-effectiveness of behavioral activation compared to treatment as usual for depressed older adults in primary care: a cluster randomized controlled trial

IntroductionDepression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown. Methods An economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios. Results Societal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95% CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95% CI -0.015 to 0.19), and QALYs (MD 0.026, 95% CI -0.0037 to 0.055). Although the ICER showed dominance of BA over TAU, the cost-effectiveness acceptability curves showed that for 0 €/unit of effect the probability of cost-effectiveness was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs. DiscussionAlthough the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.</p

Characteristics of people interviewed.

Diabetes and depression are both serious health conditions. While their relationship is bidirectional and each condition adversely affects outcomes for the other, they are treated separately. In low and middle income countries, such as Bangladesh and Pakistan, health systems are already stretched and the integration of diabetes and depression care is rarely a priority. Within this context through interviews with patients, healthcare workers and policy makers the study explored: lived experiences of people living with depression and diabetes, current practice in mental health and diabetes care and barriers and perspectives on integrating a brief psychological therapy into diabetes care. The findings of the study included: differing patient and practitioner understandings of distress/depression, high levels of stigma for mental health and a lack of awareness and training on treating depression. While it was apparent there is a need for more holistic care and the concept of a brief psychological intervention appeared acceptable to participants, many logistical barriers to integrating a mental health intervention into diabetes care were identified. The study highlights the importance of context and of recognising drivers and understandings of distress when planning for more integrated mental and physical health services, and specifically when adapting and implementing a new intervention into existing services.</div

COREQ (COnsolidated criteria for REporting Qualitative research) checklist completed for the reported study in the manuscript.

COREQ (COnsolidated criteria for REporting Qualitative research) checklist completed for the reported study in the manuscript.</p