Fletcher, S, Chondros, P, Densley, K, Murray, E, Dowrick, C 
ORCID: 0000-0002-4245-2203, Coe, A, Hegarty, K, Davidson, S, Wachtler, C, Mihalopoulos, C et al (show 4 more authors)
(2021)
Matching depression management to severity prognosis in primary care: Results of the target-D randomised controlled trial
British Journal of General Practice, 71 (703).
E85-E94.
ISSN 0960-1643, 1478-5242
Abstract
Background Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required. Aim To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care. Design and setting Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18–65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care. Method The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months. Results In intention to treat analysis, estimated between-arm difference in mean PHQ-9 scores at 3 months was –0.88 (95% confidence interval [CI] = –1.45 to –0.31) favouring the intervention, and –0.59 at 12 months (95% CI = –1.18 to 0.01); standardised effect sizes of –0.16 (95% CI = –0.26 to –0.05) and –0.10 (95% CI = –0.21 to 0.002), respectively. No serious adverse events were reported. Conclusion Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Prognosis, Treatment Outcome, Depression, Quality of Life, Adolescent, Adult, Aged, Middle Aged, Primary Health Care, Australia, Young Adult |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 20 Jul 2021 09:36 |
| Last Modified: | 24 Jan 2026 02:53 |
| DOI: | 10.3399/BJGP.2020.0783 |
| Open Access URL: | https://doi.org/10.3399/BJGP.2020.0783 |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3130695 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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