Preventing relapse of depression in primary care: a pilot study of the "Keeping the blues away" program

Abstract

Objectives: To determine the effectiveness of “Keeping the blues away” (KBA), a manualised depression relapse prevention program for general practice, in reducing the relapse of depression compared with usual care (with the aim of halving the relapse rate), and in reducing depression severity and improving the process of care. Design and setting: A cluster randomised controlled trial conducted in 2004–2005 in South Australian general practices. Participants: 43 general practitioners from 23 urban and rural practices recruited 110 patients with depression (age range, 18–75 years). Intervention: GP training manual or patient manual and relaxation CD; 20 hours of training on depression, the study protocol, assessment tools and skills. Main outcome measures: Relative risk (RR) of depression relapse; depression severity and quality of life scores. Results: There were no significant differences in relapse rates between the groups (χ21 = 1.51; P = 0.23), although there was a non-significant tendency for relapse to be reduced in the KBA group (RR = 0.77; 95% CI, 0.50–2.05). Older patients (≥ 50 years) in the KBA group showed a significantly lower probability of relapse than those in the control group (P = 0.018). There was a decrease in depression scores in both groups. KBA participants had more severe depression at baseline, and the reduction in severity in those with symptoms for >6 months was nearly significant (P = 0.06). KBA was positively received by GPs and patients. Conclusions: Although this pilot study of a small sample did not achieve its primary outcome of reducing depression relapse by 50%, KBA was found to be a promising program for older patients and for those with more severe or persistent symptoms.