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Rodgers M, Asaria M, Walker S, et al. The Clinical Effectiveness and Cost-Effectiveness of Low-Intensity Psychological Interventions for the Secondary Prevention of Relapse After Depression: A Systematic Review. Southampton (UK): NIHR Journals Library; 2012 May. (Health Technology Assessment, No. 16.28.)

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The Clinical Effectiveness and Cost-Effectiveness of Low-Intensity Psychological Interventions for the Secondary Prevention of Relapse After Depression: A Systematic Review.

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2Definition of decision problem

Decision problem

The decision problem concerns the clinical effectiveness and cost-effectiveness of low-intensity psychological interventions to prevent relapse or recurrence in patients who have received and responded to treatment for depression.

As discussed above, the terms relapse and recurrence are not consistently used in the literature. Therefore, we have considered both relapse and recurrence; we will refer to relapse or recurrence in our discussions unless a clear distinction has been made between the terms, but when reporting the findings of identified studies we will use the terminology as defined by individual study authors.

There is a lack of a clear, generally agreed on definition of low-intensity psychological interventions. We chose to emphasise the characteristic of the practitioner delivering the treatment as the main defining feature because of the current policy and practice context in the UK. Low-intensity psychological interventions are predominantly used in IAPT services, and in these services they are delivered by PWPs, who do not have formal health-care professional or CBT therapist qualifications.

However, in recognition that the definition of low intensity remains unclear, we also considered a broader definition of brief interventions typically delivered by clinical psychologists, CBT therapists, and other qualified mental health professionals involving limited patient contact time (delivered in a group setting or involving brief individual encounters). An inclusion threshold of 6 hours of contact per patient was used to select these intervention studies. We did not distinguish between the types of group intervention, although there is a very wide range; some interventions, such as psychoeducational groups and large community-based interventions, are low intensity, whereas others are high intensity and require high-level group therapy skills. For group interventions, the total contact time of the mental health professional(s) was divided by the number of patients in the group to create an average duration per patient. Although of less direct relevance to the decision problem, these interventions may be of interest to decision-makers concerned with improving access to psychological therapies, and so the literature in this area is briefly described and classified in a scoping review. Thus, the review was conducted in two parts as described below.

Overall aims and objectives

The main aims of this project are to determine the clinical effectiveness and cost-effectiveness of low-intensity psychological or psychosocial interventions to prevent relapse or recurrence in patients with depression.

As the broader definition of ‘low-intensity’ psychological intervention is somewhat contested, and the resources of the review were limited, the review was conducted in two parts:

  1. A systematic review of all evaluations of ‘low-intensity’ interventions that were delivered by para-professionals, peer supporters or PWPs as defined by the IAPT programme. Such evaluations were not restricted by length of treatment or number of sessions.
  2. A scoping review of all relevant evaluations of interventions involving qualified mental health professionals (e.g. psychiatrists, clinical psychologists, CBT therapists) involving < 6 hours of contact per patient.
© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK99982

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