UCL Research Department of Primary Care and Population Health

Introduction: Care for people with long-term depression is often inconsistent, with significant psychological, physical and social morbidity
and high financial costs.

Aims of the ProCEED study (Pro-active care and its evaluation for enduring depression):
(1) To establish whether structured, pro-active care of primary care patients with chronic depression leads to cost-effective improvement
in medical and social outcomes compared with usual general practitioner (GP) care.
(ii) To assess whether training general practice nurses leads to improved assessment and follow-up of patients with chronic depression
and provides on-going skills in this area

Methods: Recruitment was from 42 UK general practices. Eligible participants had chronic major or recurrent major depression or chronic dsythymia
confirmed by Composite International Diagnostic Interview (CIDI) and scored 14 or above on the Beck Depression Inventory (BDI-II).
Consented participants were randomised to GP treatment as usual (controls) or the practice nurse intervention.

Qualitative in-depth interviews were conducted with 15/42 practice nurses and 26/282 Intervention patients

Results: The early trial results are promising and show a positive effect of the nurse intervention on the BDI-II results and a significantly positive effect
on the WASAS questionnaire, which measures how people are functioning in their lives. We are still awaiting the health economics analysis.

In the qualitative study most intervention patients reported positive impacts -  both on mental health and other areas of their life.
All nurses interviewed reported improved confidence in dealing with mental health issues and most reported a beneficial impact on their clinical skills.

Conclusions: The trial results should have significant implications for the management of depression in primary care and the potential role of practice nurses.