title: A pragmatic randomized controlled trial of a guided self-help intervention versus a waiting list control in a routine primary care mental health service.
abstract: OBJECTIVES. To evaluate the effectiveness of a two session guided self-help (GSH) intervention provided by primary care graduate mental health workers (PCGMHWs) in a primary care mental health service. DESIGN. Pragmatic randomized trial, with a wait list control design. METHOD. Patients presenting with significant anxiety and depression problems were given one or more self-help booklets at screening and randomly allocated to an immediate (ITG) or delayed treatment group (DTG). Following this, a two-session GSH intervention was provided by one of two PCGMHWs, with a review session to decide on the need for further intervention. The DTG began the intervention 8 weeks after the screening and the primary outcome was Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) scores after 8 weeks. RESULTS. A total of 63 patients were allocated to the ITG, 59 to the DTG. Analysis of covariance, carried out on an intention to treat basis, showed a significant treatment effect, F(1,98) = 15, p < .001, and a comparison of means at 8 weeks showed a significant difference, t(116) = 2.1 (95% CI [1.1, 5.9]), p= .042 with an effect size, d= 0.375. Taking the two groups together, CORE-OM scores for patients who completed the intervention reduced between screening and the review session by an average of 7.9 (95% CI [6.3, 9.5]), effect size of 1.2. Between screening and the review session, 47% showed a reliable and clinically significant improvement. CONCLUSIONS. The study provides some support for the effectiveness of a two-session GSH intervention and a stepped-care service model.
authors.affiliation: University of Huddersfield, UK. m.lucock@hud.ac.uk
authors.forename: Mike
authors.initials: M
authors.lastname: Lucock
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kirby
authors.forename: Nigel
authors.initials: N
authors.lastname: Wainwright
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D024382:Professional Role / Q000523:psychology; D011581:Psychological Tests; D012657:Self-Help Groups; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists