title: CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option.
  
  
  METHODS
  CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial.
  
  
  CONCLUSIONS
  Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care.
  
  
  BACKGROUND
  ISRCTN45842879 (24 July 2012).
authors.forename: Karen
authors.initials: K
authors.lastname: Overend
authors.forename: Helen
authors.initials: H
authors.lastname: Lewis
authors.forename: Della
authors.initials: D
authors.lastname: Bailey
authors.forename: Kate
authors.initials: K
authors.lastname: Bosanquet
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.forename: David
authors.initials: D
authors.lastname: Ekers
authors.forename: Samantha
authors.initials: S
authors.lastname: Gascoyne
authors.forename: Deborah
authors.initials: D
authors.lastname: Hems
authors.forename: John
authors.initials: J
authors.lastname: Holmes
authors.forename: Ada
authors.initials: A
authors.lastname: Keding
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
authors.forename: Shaista
authors.initials: S
authors.lastname: Meer
authors.forename: Jodi
authors.initials: J
authors.lastname: Meredith
authors.forename: Natasha
authors.initials: N
authors.lastname: Mitchell
authors.forename: Sarah
authors.initials: S
authors.lastname: Nutbrown
authors.forename: Steve
authors.initials: S
authors.lastname: Parrott
authors.forename: David
authors.initials: D
authors.lastname: Richards
authors.forename: Gemma
authors.initials: G
authors.lastname: Traviss
authors.forename: Dominic
authors.initials: D
authors.lastname: Trépel
authors.forename: Rebecca
authors.initials: R
authors.lastname: Woodhouse
authors.affiliation: Department of Health Sciences, University of York, Seebohm Rowntree, Building, Heslington, York YO10 5DD, UK. simon.gilbody@york.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
mesh_terms: D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000191:economics; D019090:Case Management; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000628:therapy*; D004739:England; D058005:General Practitioners; D017048:Health Care Costs; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team / Q000191:economics; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000191:economics; D017064:Process Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents