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Volume 50 Issue 3 (September 2011), Pages 223-338

A pragmatic randomized controlled trial of a guided self‐help intervention versus a waiting list control in a routine primary care mental health service (pages 298-309)

Objectives. To evaluate the effectiveness of a two session guided self‐help (GSH) intervention provided by primary care graduate mental health workers (PCGMHWs) in a primary care mental health service.

Design. Pragmatic randomized trial, with a wait list control design.

Method. Patients presenting with significant anxiety and depression problems were given one or more self‐help booklets at screening and randomly allocated to an immediate (ITG) or delayed treatment group (DTG). Following this, a two‐session GSH intervention was provided by one of two PCGMHWs, with a review session to decide on the need for further intervention. The DTG began the intervention 8 weeks after the screening and the primary outcome was Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) scores after 8 weeks.

Results. A total of 63 patients were allocated to the ITG, 59 to the DTG. Analysis of covariance, carried out on an intention to treat basis, showed a significant treatment effect, F(1,98) = 15, p < .001, and a comparison of means at 8 weeks showed a significant difference, t(116) = 2.1 (95% CI [1.1, 5.9]), p= .042 with an effect size, d= 0.375. Taking the two groups together, CORE‐OM scores for patients who completed the intervention reduced between screening and the review session by an average of 7.9 (95% CI [6.3, 9.5]), effect size of 1.2. Between screening and the review session, 47% showed a reliable and clinically significant improvement.

Conclusions. The study provides some support for the effectiveness of a two‐session GSH intervention and a stepped‐care service model.

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