Effectiveness of Models of Care for Treating Mild to Moderate Depression in Primary Care: A Systematic Review

Problem

The majority of people with depression present to primary care for treatment. However, treatment in this setting is mainly based on studies that involve secondary care patients, which may not be appropriate as primary care patients often have a milder form of depression. We aimed to determine the effectiveness of models of care for the management of mild to moderate depression in primary care and to determine the most effective interventions for reducing mild to moderate depression in primary care for specific at-risk or hard-to-access groups (e.g. CALD patients, refugees, and chronically ill patients).

Approach

Three databases were systematically searched (Medline, PubMed, Cochrane Database of Systematic Reviews) for studies published in the last 10 years. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data, and assessed article quality.

Findings

Of the 174 identified records, 12 met inclusion criteria with 9 assessed as having a low risk of bias. Ten interventions were evaluated; the majority focused on moderate depression. Cognitive behavioural therapy (CBT) was a component of 60% of interventions: 83% of these included self-management and 67% relied on technology. A nurse-led psycho-educational group program was strongly indicated to reduce depressive symptoms. Online CBT with minimal therapist support was also indicated but effectiveness is limited to patients with a higher educational level. For at-risk groups (chronic illness), self-managed CBT and telemedicine-based collaborative care were indicated to improve disease-specific quality of life and medication adherence, respectively. No studies met inclusion criteria for hard-to-access groups (e.g. migrants).

Consequences

Interventions with CBT components were more effective than those without, irrespective of delivery format. However, research is urgently required to develop and evaluate primary care interventions for treating mild depression and mild to moderate depression for at-risk and hard-to-access groups.