Counselling versus low-intensity cognitive behavioural therapy for persistent sub-threshold and mild depression (CLICD): a pilot/feasibility randomised controlled trial.
BACKGROUND
Persistent depressive symptoms below the threshold criteria for major depression represent a chronic condition with high risk of progression to a diagnosis of major depression. The evidence base for psychological treatments such as Person-Centred Counselling and Low-Intensity Cognitive Behavioural Therapy for sub-threshold depressive symptoms and mild depression is limited, particularly for longer-term outcomes.


METHODS
This study aimed to test the feasibility of delivering a randomised controlled trial into the clinical and cost effectiveness of Low-Intensity Cognitive Behavioural Therapy versus Person-Centred Counselling for patients with persistent sub-threshold depressive symptoms and mild depression. The primary outcome measures for this pilot/feasibility trial were recruitment, adherence and retention rates at six months from baseline. An important secondary outcome measure was recovery from, or prevention of, depression at six months assessed via a structured clinical interview by an independent assessor blind to the participant's treatment condition. Thirty-six patients were recruited in five general practices and were randomised to either eight weekly sessions of person-centred counselling each lasting up to an hour, or up to eight weeks of cognitive-behavioural self-help resources with guided telephone support sessions lasting 20-30 minutes each.


RESULTS
Recruitment rate in relation to the number of patients approached at the general practices was 1.8 %. Patients attended an average of 5.5 sessions in both interventions. Retention rate for the 6-month follow-up assessments was 72.2 %. Of participants assessed at six months, 71.4 % of participants with a diagnosis of mild depression at baseline had recovered, while 66.7 % with a diagnosis of persistent subthreshold depression at baseline had not developed major depression. There were no significant differences between treatment groups for both recovery and prevention of depression at six months or on any of the outcome measures.


CONCLUSIONS
It is feasible to recruit participants and successfully deliver both interventions in a primary care setting to patients with subthreshold and mild depression; however recruiting requires significant input at the general practices. The evidence from this study suggests that short-term Person-Centred Counselling and Low-Intensity Cognitive Behaviour Therapy are potentially effective and their effectiveness should be evaluated in a larger randomised controlled study which includes a health economic evaluation.


BACKGROUND
Current Controlled Trials ISRCTN60972025 .
Federal University of Juiz de Fora, Research Center in Spirituality and Health - NUPES School of Medicine, Av. Eugênio do Nascimento s/n°, Bairro Dom Bosco, CEP: 36038-330, Juiz de Fora, MG, Brazil. bethfrei@gmail.com.
Elizabeth
E
Freire
Psychosocial Psychiatry, Institute of Health and Wellbeing, University of Glasgow, Administration Building Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK. chris.williams@glasgow.ac.uk.
Christopher
C
Williams
Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building University Avenue, Glasgow, G12 8QQ, UK. martina.messow@glasgow.ac.uk.
Claudia-Martina
CM
Messow
Department of Psychology, University of Roehampton, Holybourne Avenue, London, SW15 4JD, UK. mick.cooper@roehampton.ac.uk.
Mick
M
Cooper
Counselling Unit, School of Psychological Sciences & Health, University of Strathclyde, GH507 Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK. robert.elliott@strath.ac.uk.
Robert
R
Elliott
Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building University Avenue, Glasgow, G12 8QQ, UK. alex.mcconnachie@glasgow.ac.uk.
Alex
A
McConnachie
Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building University Avenue, Glasgow, G12 8QQ, UK. andrew.walker@glasgow.ac.uk.
Andrew
A
Walker
Counselling Unit, School of Psychological Sciences & Health, University of Strathclyde, GH507 Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK. deborah.heard@gmail.com.
Deborah
D
Heard
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK. jill.morrison@glasgow.ac.uk.
Jill
J
Morrison
D000328:Adult; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D003863:Depression / Q000517:prevention & control* / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods; D011614:Psychotherapy, Brief / Q000379:methods