Preventing depression study: PERSUADE Preventing depression in the community through non-traditional providers—A feasibility study and qualitative process evaluation

Abstract

ABSTRACT Title: Preventing-depression study: PERSUADE Preventing depression in the community through non-traditional providers—A qualitative process evaluation. Background: Depression is the leading cause of disability worldwide and it is a major contributor to the overall global burden of disease. The number of people with depression is increasing globally, with more than 300 million people affected. Treatments for depression have limited usefulness and have only led to a 35% reduction in cases of depression, as compared to those receiving no treatment. The primary aim was to reduce depression-symptom scores and prevent the development of depression in people with subthreshold depression, defined as a PHQ score in the range of 5¬–9 (Kroenke et al., 2001). The study followed the MRC framework (Craig et al., 2008), for the development and evaluation of complex interventions. Methods: The study focused on both qualitative and quantitative methods which were, conducted over three phases. Phase1: looking at what was already done on development, content and delivery of the Prevent Depression Courses, running psychological interventions for people with subthreshold depression. We ran four community-engagement events: engagement in the community, stakeholder consultation with discussions based on the development of participant-and-facilitator manual. Phase 2: Adaptation of the intervention manual, different types of recruitment strategy, the details on intervention delivery and acceptability, including facilitators’ characteristics, training and supervision. Phase 3: Delivery, feasibility and acceptability of the newly adapted psychological intervention for adults with subthreshold depression. Finally, a process of mixed-methods data analysis was used to guide further implementations and evaluation in a full trial. Feasibility and acceptability studies were conducted with 64 participants. Thirty-two were randomised to the intervention arm and thirty-two to the control arm. Results: The outcomes were assessed using a number of standardised tools for depression. The rates of depression were also measured before workshop attendance and at follow-up. Qualitative interviews were conducted with 15 participants who completed the intervention, and at follow-up with workshop facilitators. There was an overall reduction in rates of depression after the intervention workshops across the sample. The results showed that the facilitators had the skill and capacity to deliver the one-day workshop. A number of practical barriers were experienced in the development and delivery of the interventions. Common practical barriers were based on the recruitment of the participants into the study, while the retention rates depended on number of participants who remained in the study and their acceptability for delivery of the interventions. If such programs were to be implemented, it would be necessary to have relevant training, supervision and monitoring mechanisms to ensure therapists’ competence and the offer of a high quality of treatment. The overall implementation, evaluation and outcomes showed that the intervention was both feasible and acceptable to the participants and that it can be moved from the primary-care setting to voluntary-sector organisations. In addition to reducing costs, the intervention could also be important in enhancing treatment adherence. Conclusions : Whilst the aim of the PERSUADE study was to look at the feasibility and acceptability of the workshops, there is a need to identify cost-efficient and long-lasting interventions in order to prevent the development of subthreshold depression into major depressive disorder. The feasibility of the PERSUADE study demonstrates how further studies and trials are needed to access the effectiveness and efficacy of the intervention and the delivery of the one-day workshop in community settings. This would help to further refine interventions and evaluate their use in diverse popula

Date of Award	1 Aug 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Peter Bower (Supervisor) & Cassandra Kenning (Supervisor)