Evaluating the Treatment Landscape for Depression

Introduction

A GP surgery is looking to better understand and evaluate its approach in the treatment of mental health issues, with specific regards to depression. Depression is a mental disorder that is typically characterized by feelings of low mood, sadness, loss of interest in daily life and/or pleasurable activities, poor self-esteem and trouble with sleeping patterns and appetite. Other symptoms include poor concentration, fatigue, hopelessness, anxiety, aches and pains as well as feeling suicidal. Depression can severely impact an individual’s quality of life, self-image or perception and well-being. According to the World Health Organization (WHO), there are over 350 million people globally suffering from this condition and it is the leading cause of disability in the world, contributing to a significant global burden of disease. For those struggling to manage their symptoms, seeking psychology dissertation help can provide valuable insights and support. Depression can become a very serious health condition and mental health issues are considerably on the rise, and are both a public and global health issue.

There has been considerable research into approaches to treating depression, and many well-known forms of treatment. These vary according to person and severity of depressive symptoms, but can include the use of antidepressant medications – such as selective serotonin reuptake inhibitors (SSRIs), psychological talking therapies – including cognitive based therapy (CBT) and over various forms of psychotherapy. Treatment can include a combination of these approaches and can be modified depending on whether the depression is classified as mild, moderate or severe. Whilst antidepressant medication has been shown to be considerably effective in the treatment of depression and reducing depressive symptoms – they should be used with caution and should not be the first line of treatment, especially for children and adolescents or for people with mild depression. Research also suggests that certain forms of talking therapies can be particularly useful in reducing depressive symptoms and episodes as they tend to focus on the underlying issues an individual may have. CBT has been shown to be more effective when it is combined with antidepressants rather than relying on the use of antidepressants alone. It can, however, be difficult to know which method of treatment is most effective in treating depression – as this will clearly vary between different people – depending on their particular needs.

Mindfulness-based cognitive therapy (MCBT) is a type of psychological therapy, which uses traditional CBT in addition to mindfulness-based techniques, including mindfulness and meditation. Its theory is based on the idea that individuals who are suffering from major depressive disorder are much more likely to go onto relapse, and typically suffer from ongoing episodes of depression. This is due to ongoing patterns of negative thinking, low mood, rumination and self-criticism. MCBT attempts to treat depressive symptoms by guiding depressed patients into a deeper understanding of their negative patterns of thinking. Patients are taught how to gain acceptance and awareness of their thoughts in the present moment – and learn how to not attach or react negatively to them, in a process known as decentering. The goal of MCBT is to break the pattern that is typically seen in depressive patients’ automatic cognitive thought processes which go on to spark and initiate a depressive vicious cycle. Patients learn how to become aware of when these thought processes occur – and to adjust their reaction towards them – into a more reflective observation, focusing on awareness and acceptance. Research has shown that MCBT can be an effective form of treating depression, especially for individuals with a history of depressive episodes, and can prevent further relapses. And it can be used either on its own or in conjunction with antidepressant medication. However, more research into MCBT is needed to ascertain how effective it is as a treatment method.

An intervention was carried out over 6 weeks, using 45 patients, with the aims to answer the following research question; Is the combination of MCBT and Antidepressants more Effective in the Treatment of Depression, than the use of Antidepressants alone?

The remainder of this report will set out to answer this question using the following 5 aims:

Aim 1: To determine if there is a statistical significant difference in post-depression scores between male and female participants at time 3, whilst controlling for age.

Aim 2: To determine whether there was a significant difference in self-image index from time 1 to time 3.

Aim 3: To determine if there is a statistically significant relationship between depression score and self image at time 1.

Aim 4: To determine whether males are more self-referred than females.

Aim 5: To determine whether depression scores differ between time 1 and time 3 in the intervention and control group.

Method

Data Source, Intervention and Collection

A GP practice in Brighton, UK, looking to evaluate and better understand the effectiveness of MCBT within the therapy or counseling of depressed patients carried out an intervention over 6 weeks, in which a committee approved ethics for this study. The participants in this study were all classified as having mild/moderate to severe depression and were all currently being treated with antidepressant medication and registered at the same practice, but were not undergoing any form of CBT or counseling. All participants gave written consent to participate in the study, and this study only included individuals over 18 years of age, and participants were randomly selected. In total there were 45 participants in which 53.3% were female (24 females) and 46.7% were male (21 males). The mean age of this group was 34.16 in years and standard deviation (SD) of 3.38.

The group was split into a control and intervention group – in which the control group received their regular treatment of antidepressant medication alone, and the intervention group received their regular treatment of antidepressants alongside MCBT over a period of 6 weeks. A MCBT Intervention Program was delivered to participants in the intervention group. In which participants were given 2hrs of MCBT per week with a trained psychologist professional in face-to-face counseling sessions, which took place in the GP surgery. The intervention group was trained in mindfulness and meditation, and given in-depth advice of how to use this outside of therapeutic sessions, in their day-to-day lives, in order to reduce depressive symptoms. The control group received no MCBT or training. Both groups were given a diary in order to record their thoughts and feelings in order to monitor their symptoms over the duration of the study, and participants were in contact with their doctor and psychologist throughout the intervention to monitor progress.

Additionally, participants were instructed to fill out and complete a highly detailed, structured and designed questionnaire at 3 time points, at the start of the treatment (Time 1), at the end of treatment (Time 2), and 6 weeks after treatment had ended (Time 3). The questionnaire included in depth questions about… and participants were also instructed to report on their self-image, using a scale from 0-15, with 0 being very poor self-image to 15 – excellent self-image. Self-image was used to depict how participants felt about their quality of life and self-esteem, and how they felt about themselves (self-perception). Questionnaires were submitted back to the GP surgery and this information/data was used to assign a depression score and a self-image index score at each of these time points for each participant, and data was safely uploaded onto computer software.

Study Design, Type of Variables and Data

The type of research and study carried out was a cross sectional study design – this was because it evaluated the results from a dataset from the given population. It gives a ‘snapshot’ at a particular point in time which further suggests this study was cross sectional. This type of study design is observational in that it analyses data from a dataset from the participants included in this study. There are both advantages and disadvantages to this study design, which will be discussed further in the discussion section of this report.

The variables included in this study for analysis were:

The gender of participants – this was a categorical variable - in which females were coded as 0 and males as 1.

The age of participants – this is a scale and/or continuous variable.

The intervention group and control group – which is categorical – in which intervention group was coded as 1 and the control group as 0.

Depression test scores – was a scale variable – these were measured at 3 time points; Time 1, Time 2 and Time 3, and referred to participants depressive thoughts and feelings (a higher score depicting more severe depression).

Self-image scores – were an ordinal variable – in which the scale was set at 0 to 15 – in which 0-4 (very poor-low self image), 5-9 (adequate to good self image), 9-12 (good to very good self image) and 13-15 (very good to excellent self-image). These were measured at 3 time points, Self-image 1 - depicting self-image of participant at the start of treatment, Self-image 2 - during treatment and Self-image 3 - post treatment.

Self-referred is a categorical variable and this depicted whether patients were self-referred or not (providing further detail of self-motivation of the participant). This was coded as 0 – meaning they were not self-referred (but referred by an independent professional, such as a psychiatrist), and 1 – meaning they referred themselves, upon their own decision.

Statistical Data Analysis

Analysis of the data was carried out on SPSS statistics version 22.0 (IBM Corporation), in which there was a combination of both between and within subjects study design. Data was analyzed using a variety of statistical tests and tabular and graphical data was produced. The findings of the analysis are presented below in the results section.

Results

Aim 1: To determine if there is a statistical significant difference in post-depression scores between male and female participants at time 3, whilst controlling for age.

Aim 2: To determine whether there was a significant difference in self-image index from time 1 to time 3.

Aim 3: To determine if there is a statistically significant relationship between depression score and self-image at time 1.

Aim 4: To determine whether males are more self-referred than females.

Aim 5: To determine whether depression scores differ between time 1 and time 3 in the intervention and control group.

Discussion

Summary of Findings

The results show that…

Implications for Current Research

Limitations and Future Research

A limitation of this study was that it could have used a larger sample size; this would have been more representative of the general population and could have potentially reduced the influence of outliers or unusual and extreme observations. As this was a cross sectional study – it could have been relatively feasible both in terms of time and financial costs to obtain more data and include more participants. Additionally, despite the fact that the analysis uses quantitative data, this topic of treatment of depression by its nature can be seen as qualitative – therefore a larger sample size would have provided further insight into the responses of the questionnaire. Whilst this study used a cross sectional study design which has benefits including the fact that multiple variables can be analyzed and obtained at a specific point in time, and the information can be useful for various types of future research/creating new theories and hypothesis. There are also a number of limitations to this study design – it cannot analyze behavior over a period of time and does not provide further insight into cause and effect relationships.

Future Clinical/Policy Applications

Antidepressants are over prescribed within the UK and contribute to a significant economic cost to the National Health Service (NHS). Mental health issues such as depression are on the rise and also contribute to massive socio-economic and medical costs both as direct and indirect costs. That is time taken off school or work. Taking this into account – it should be recommended that approaches like MCBT …

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