title: Practice nurse-led proactive care for chronic depression in primary care: a randomised controlled trial.
abstract: BACKGROUND
  Management of long-term depression is a significant problem in primary care populations with considerable on-going morbidity, but few studies have focused on this group.
  
  
  OBJECTIVE
  To evaluate whether structured, nurse-led proactive care of patients with chronic depression in primary care improves outcomes.
  
  
  METHODS
  Participants with chronic/recurrent major depression or dysthymia were recruited from 42 UK general practices and randomised to general practitioner (GP) treatment as usual or nurse intervention over 2 years (the ProCEED trial, trial registration:ISRCTN36610074).
  
  
  RESULTS
  In total 282 people received the intervention and there were 276 controls. At 24 months there was no significant improvement in Beck Depression Inventory (BDI-II) score or quality of life (Euroquol-EQ-VAS), but a significant improvement in functional impairment (Work and Social Activity Schedule, WSAS) of 2.5 (95% CI 0.6-4.3,P= 0.010) in the intervention group. The impact per practice-nurse intervention session was -0.37 (95% CI -0.68 to -0.07,P= 0.017) on the BDI-II score and 70.33 (95% CI 70.55 to -0.10,P= 0.004) on the WSAS score, indicating that attending all 10 intervention sessions could lead to a BDI-II score reduction of 3.7 points compared with controls.
  
  
  CONCLUSIONS
  The intervention improved functioning in these patients, the majority of whom had complex long-term difficulties, but only had a significant impact on depressive symptoms in those engaging with the full intervention.
authors.affiliation: Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK m.buszewicz@ucl.ac.uk.
authors.forename: Marta
authors.initials: M
authors.lastname: Buszewicz
authors.affiliation: Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Griffin
authors.affiliation: Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: McMahon
authors.affiliation: Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.affiliation: Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: King
mesh_terms: D057179:Advanced Practice Nursing; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome