| Methods |
RCT to compare four conditions.
Randomisation is stratified (severity of depression). Assessments on four occasions: baseline, 6, 12 and 52 weeks. |
| Participants |
151 patients (aged 18‐65) with major depression (research criteria for major depression, Hamilton rating scale score 13 or more, minimum illness duration 4 weeks) referred by 24 GPs.
Therapists: 3 research GPs (and 2 practice nurses). |
| Interventions |
T1 (n:39) = problem solving treatment (PST) by GP (stages: clarification of problems, choice of goals, generation of solutions, choice of solutions, implementation of solutions, evaluation).
T2 (n:41) = PST by practice nurse.
T3 (n:36) = fluvoxamine (100 mg) or paroxetine (20 mg) and general support.
T4 (n:35) = combination treatment (medication by GP and PST by nurse).
All groups: 6 30‐60‐min sessions in 12 weeks (except T4=12 sessions).
Therapists (GPs) received training in PST (theory, treating five patients under supervision), training manual and were supervised throughout trial. |
| Outcomes |
52 week follow‐up: no sign. differences between groups on depression (BDI, Hamilton), psychological symptoms (clinical interview schedule) or social functioning (SAS).
Recovered cases (Hamilton <8): T1=24/39, T2=23/41, T3=20/36, T4=23/35 (no significant differences). |
| Notes |
non‐compliance: T1=14/39, T2=9/41, T3=6/36, T4=6/35.
withdrawal: T1=14/39, T2=13/41, T3=6/36, T4=5/35.
no integrity check. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment? |
Low risk |
A ‐ Adequate |
