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Open Access Research article

Effectiveness of a psycho-educational group program for major depression in primary care: a randomized controlled trial

Rocío Casañas123, Rosa Catalán4567*, Jose Luis del Val3, Jordi Real3, Sergi Valero78 and Miquel Casas78

Author Affiliations

1 Research Department. Centre Higiene Mental (CHM) Les Corts, c/ Numancia, 103-105, Bajos, 08029, Barcelona, Spain

2 Psychiatry and Legal Medicine Department, Universidad Autónoma de Barcelona, Barcelona, Spain

3 Barcelona Research Support Unit in Primary Care. IDIAP Jordi Gol, Catalan Institute of Health, Barcelona, Spain

4 Clinical Institute of Neurosciences (ICN), Hospital Clinic, C/ Villarroel 170, 08036, Barcelona, Spain

5 Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain

6 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

7 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain

8 Department of Psychiatry, Hospital Universitari Vall d’Hebron, C/Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain

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BMC Psychiatry 2012, 12:230  doi:10.1186/1471-244X-12-230

Published: 18 December 2012

Abstract

Background

Studies show the effectiveness of group psychoeducation in reducing symptoms in people with depression. However, few controlled studies that have included aspects of personal care and healthy lifestyle (diet, physical exercise, sleep) together with cognitive-behavioral techniques in psychoeducation are proven to be effective.

The objective of this study is to assess the effectiveness of a psychoeducational program, which includes aspects of personal care and healthy lifestyle, in patients with mild/moderate depression symptoms in Primary Care (PC).

Methods

In a randomized, controlled trial, 246 participants over 20 years old with ICD-10 major depression were recruited through nurses/general practitioners at 12 urban Primary Care Centers (PCCs) in Barcelona. The intervention group (IG) (n=119) received a group psychoeducational program (12 weekly, 1.5 h sessions led by two nurses) and the control group (CG) (n=112) received usual care. Patients were assessed at baseline and at, 3, 6 and 9 months. The main outcome measures were the BDI, EQ-5D and remission based upon the BDI.

Results

231 randomized patients were included, of whom 85 had mild depression and 146 moderate depression. The analyses showed significant differences between groups in relation to remission of symptoms, especially in the mild depression group with a high rate of 57% (p=0.009) at post-treatment and 65% (p=0.006) at 9 month follow up, and only showed significant differences on the BDI at post-treatment (p=0.016; effect size Cohen’s d’=.51) and at 6 and 9 month follow-up (p= 0.048; d’=.44).

In the overall and moderate sample, the analyses only showed significant differences between groups on the BDI at post-treatment, p=0.02 (d’=.29) and p=0.010 (d’=.47), respectively.

The psychoeducation group improved significantly on the EQ-5D at short and long-term.

Conclusions

This psychoeducational intervention is a short and long-term effective treatment for patients with mild depression symptoms. It results in a high remission rate, is recommended in PC and can be carried out by nurses with previous training. In moderate patients, group psychoeducation is effective in the short-term.

Trial registration

Clinical Trials.gov identifier NCT00841737

Keywords:
Depression; Primary Care; Psycho-educational; Clinical trials; Nurse