Case finding for depression in primary care - CASCADE study v1.0
Research type
Research Study
Full title
Case finding for depression in primary care: a regression discontinuity design CASCADE study
IRAS ID
305842
Contact name
Caroline Fairhurst
Contact email
Sponsor organisation
Tees Esk and Wear Vally NHS Foundation Trust
ISRCTN Number
ISRCTN11841241
Duration of Study in the UK
1 years, 4 months, 31 days
Research summary
One in four people aged 65 plus are depressed. Most don't receive help from the NHS. In the UK there is little evidence that actively trying to find out who has depression to offer help (aka screening) could improve this situation. When we screened 895 podiatry patients aged 65 plus for depression in a previous falls prevention trial, it reduced symptoms among the severely depressed (about 6 in 100 people).
Participants completed the Geriatric Depression Scale (GDS) questionnaire when joining the trial, and after six and 12 months. If their score suggested severe depression, we alerted their GP (for ethical reasons) and asked them to contact the patient. We measured the impact of this six months later.
We will repeat this study involving more people. We will recruit 2000 participants across northern England by post. We will ask them to complete the GDS and questions on quality of life and some general background information. They will receive the same questionnaire again after six months, with questions about any GP visits, medications and treatments they have received in the last six months. This will help us determine if screening and making recommendations to GPs is good value for money.In addition, we will interview GPs, practice managers and practice nurses (20 in total) from 10 GP practices in the north of England to learn about treatments offered to depressed elderly people, and explore if and how screening could be incorporated in practice. We will interview 25 participants about their views on screening for depression to aid understanding on its acceptability.
We will work with patient contributors on aspects such as the content and wording of information for (potential) participants and the general public. We will share study results with participants and publish in open access, peer-reviewed medical journals, and publications aimed at GPs.
Lay summary of study results: Why and how we did the study?
About a quarter of older people are depressed. Most do not receive help from the NHS. We wanted to know if screening older people for depression to get them the help they need – would reduce their symptoms of depression after six months.What did we do?
We contacted 15,849 patients from 15 GP practices in the North of England and 1020 agreed to participate. We asked them to compete a questionnaire. If answers indicated that a participant might be depressed, we let them and their GP know, so they could take action. Participants completed our questionnaire again six months later. We then checked whether their symptoms of depression had decreased.
We interviewed patients, doctors and nurses to find out what they think about screening and what actions they took based on screening results.What did we find?
We found a very small decrease in participants' depression scores after six months, among those with depressive symptoms. This wasn't enough to say that screening was helpful or that the additional cost of screening would be value for money for the NHS. The interviews revealed that participants thought the study might help people talk to their GP about feeling depressed. Some did not get the support they wanted from their GP. Patients thought it would be a good idea to keep sending out the questionnaire after the study had finished. Doctors and nurses who helped organise the study were not sure about this. They said they might not have the time and money. There were also concerns that very depressed people may not complete the form.What does this mean?
We believe that it is unlikely that the screening method used in our study will help people with depression feel better after six months.REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
22/YH/0119
Date of REC Opinion
17 Jun 2022
REC opinion
Favourable Opinion