title: Mindfulness-based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care.
abstract: This study examined the effectiveness of mindfulness-based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle- and high-income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence-based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person-centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre-test to post-test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression.
authors.affiliation: Department of Psychology, Gothenburg University, Göteborg, Sweden.|Center for Research and Development, Evidens University College, Göteborg, Sweden.|Närhälsan Health Clinic, Kållekärr, Sweden.
authors.forename: Josefine L
authors.initials: JL
authors.lastname: Lilja
authors.affiliation: Center for Research and Development, Evidens University College, Göteborg, Sweden.
authors.forename: Clara
authors.initials: C
authors.lastname: Zelleroth
authors.affiliation: Department of Psychology, Gothenburg University, Göteborg, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Axberg
authors.affiliation: Center for Research and Development, Evidens University College, Göteborg, Sweden.|Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden.
authors.forename: Torsten
authors.initials: T
authors.lastname: Norlander
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications / Q000517:prevention & control; D003866:Depressive Disorder / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D015203:Reproducibility of Results; D012537:Scandinavian and Nordic Countries; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome; D015928:Cognitive Behavioral Therapy
keywords: MBCT; Major depressive disorder; Scandinavian Primary Health Care; benchmarking; relapse prevention; reliable change index