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An integrated mental health video consultation approach vs usual care reduced symptoms of depression and anxiety among patients attending primary care, according to study results published in The BMJ.
Researchers conducted a multicenter, stratified, assessor masked, parallel group, randomized controlled trial (PROVIDE-C; ClinicalTrials.gov Identifier: NCT04316572) in 29 primary care practices in Germany to investigate the effectiveness of PROVIDE, a new mental health service model designed to treat patients with depression and/or anxiety in primary care settings. Adults with at least moderately severe depression, moderately severe general anxiety, or combined anxiety and depression who had received no or insufficient treatment were randomly assigned 1:1 to receive the PROVIDE model, which comprised 5 real-time video sessions between the patient and a mental health specialist, or usual care (ie, brief counseling, psychotropic medication prescription) provided by a general practitioner. The primary outcome was absolute change in mean severity of symptoms of depression and anxiety, which was assessed using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) at 6 months. A mixed linear model was used in statistical analysis.
A total of 376 participants (mean age, 45; women, 63%; median number of consultations received, 5) were enrolled from 29 primary care practices, of whom 187 received PROVIDE and 189 received usual care. At baseline, 49% of participants had never received any psychiatric treatment or psychotherapy. At least 1 symptom of moderate and severe severity was experienced by 41% and 37% of participants, respectively.
At 6 months, the mean change in the PHQ-ADS score in the intervention and control group was -9.2 points (95% CI, -10.7 to -7.7) and -7.1 points (95% CI, -8.8 to -5.4), respectively (adjusted mean change difference, -2.4 points; 95% CI, -4.5 to -0.4; P = .02). A significant association between sex and the primary outcome was not observed (P =.95).
Follow-up data was available for 78% of participants in the intervention group and 71% of participants in the control group. The mean change in the PHQ-ADS score at 12 months was -11.0 points (95% CI, -12.6 to -9.4) and -8.1 points (95% CI, -9.8 to -6.4) in the intervention and control groups, respectively (mean change difference, -2.9 points; 95% CI, -5.0 to -0.7; P <.007).
Secondary outcomes at 6 months also favored the PROVIDE model vs usual care. Compared with the usual care group, the PROVIDE group demonstrated significantly greater improvements in severity of depressive symptoms, psychologic distress related to somatic symptoms, health-related quality of life, and quality and patient centeredness of chronic illness care. At 12 months, greater improvements were sustained in the intervention vs usual care group. No serious adverse events related to the intervention were reported.
Study limitations include potential selection bias, missing outcome data, unintentional unmasking, and reduced generalizability of results to diverse population samples.
“The PROVIDE model shows promise as a scalable intervention that can collectively benefit population health in terms of depression and anxiety disorders,” the researchers concluded.
