Mental health prevention and promotion in general practice settings: A feasibility study

Q2 Medicine
Miranda Budd , Gita Bhutani , Kathryn Gardner , Mark Hann , Umesh Chauhan , Sophie Jaber , Irem Shabir , Valerio Bennedetto , Andrew Clegg , Molly Lever , Farah Lunat
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引用次数: 0

Abstract

Background

Mental health problems are typically addressed and intervened through a reactive approach rather than a proactive or preventative one. The aim of this feasibility RCT was to explore the possibility of recruiting to, and delivering a brief psychological intervention, focusing upon mental health prevention and promotion, in General Practice (GP).

Methods

This was a two-arm feasibility study where participants were randomised to either: treatment-as-usual (TAU) from their General Practitioner; or to a brief psychological intervention. Sixty-four participants, aged 16 and over, from 10 GP surgeries, with mild to moderate mental health difficulties, as measured by the PHQ9 and GAD7, were recruited. Intervention engagement data were summarised utilising descriptive statistics. Descriptive statistics were used to summarise clinical outcome measures at baseline and follow-up and to informally compare the two groups. Cost-effectiveness was investigated using descriptive statistics to analyse the resource use of participants and Health-Related Quality of Life (HRQoL). Qualitative data were analysed through thematic analysis and interpret in relation to Normalisation Process Theory, to understand implementation processes and the intervention's mechanism of change (facilitators and barriers).

Results

The recruitment target was met within the set timeframe. 230 patients were screened for eligibility, 72 of which were eligible and 64 were randomised. 80 % were female and 91.5 % identified as being white British. 19 dropped out, 9 of which were in the intervention arm and 10 from the TAU arm. The most frequent reason was reported as, no longer requiring support or being uncontactable. Clinical outcome measures were completed and demonstrated sensitivity to change. No participant safety factors were reported which would limit a larger trial and health economic data was collated. All of the progression criteria were classified as ‘amber’ meaning that progression to a definitive randomised controlled trial is warranted but modifications to improve recruitment, intervention engagement and participant retention is needed. Qualitative feedback was generally positive, with participants noticing therapeutic benefit, commenting on the ease of access and General Practitioners found the offer fitted well within GP.

Discussion

As a feasibility trial, the results demonstrate that individuals in GP can be recruited to a trial focusing upon the delivery of a brief psychological intervention and the required clinical assessments to assess effectiveness can be obtained. Qualitative feedback was positive from participants and GP staff and early indications seemed to demonstrate an improvement in wellbeing and a reduction in anxiety and depression. However, modifications for a larger trial are recommended to enhance recruitment and retention.
心理健康预防和促进:一项可行性研究
心理健康问题通常是通过一种被动的方法来处理和干预的,而不是通过一种主动的或预防性的方法。本可行性随机对照试验的目的是探讨在全科医生(GP)中招募并提供简短心理干预的可能性,重点是心理健康的预防和促进。方法:这是一项两组可行性研究,参与者随机分为两组:全科医生照常治疗(TAU);或者进行简短的心理干预。该研究招募了64名参与者,年龄在16岁及以上,来自10次全科医生手术,根据PHQ9和GAD7的测量,他们有轻度到中度的精神健康问题。采用描述性统计对干预参与数据进行汇总。描述性统计用于总结基线和随访时的临床结果测量,并非正式地比较两组。使用描述性统计分析参与者的资源使用情况和与健康相关的生活质量(HRQoL)来调查成本效益。定性数据通过主题分析和解释正常化过程理论进行分析,以了解实施过程和干预的变化机制(促进因素和障碍)。结果在规定的时间内完成了招聘目标。筛选230例患者,其中72例符合条件,64例随机分组。其中80%为女性,91.5%为英国白人。19人退出,其中9人来自干预组,10人来自TAU组。据报道,最常见的原因是不再需要支持或无法联系。完成了临床结果测量并证明了对变化的敏感性。没有受试者安全因素的报告,这将限制更大的试验,并整理了健康经济数据。所有进展标准被归类为“琥珀色”,这意味着有必要进展到确定的随机对照试验,但需要修改以改善招募、干预参与和参与者保留。定性反馈通常是积极的,参与者注意到治疗的好处,评论访问的便利性,全科医生发现提供很适合全科医生。作为一项可行性试验,结果表明,全科医生的个体可以被招募到一个专注于提供简短心理干预的试验中,并且可以获得评估有效性所需的临床评估。参与者和全科医生的定性反馈是积极的,早期迹象似乎表明幸福感有所改善,焦虑和抑郁有所减少。但是,建议进行修改,进行更大规模的试验,以加强征聘和留用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Mental Health and Prevention
Mental Health and Prevention Medicine-Psychiatry and Mental Health
CiteScore
2.10
自引率
0.00%
发文量
22
审稿时长
24 days
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