Table A

Table B

Table C

Table D

Table E
 

Searches

Electronic databases

Given the broad range of study designs that are of relevance to reviews by the effective practice and organisation of care group (randomised controlled trials, controlled before and after trials, and interrupted time series) and the expectation that data of relevance to the present review might be included in studies with a different primary aim (for example, those evaluating clinical outcome of management by mental health professionals), it was decided to use a broad strategy for the identification of studies based on the types of mental health professionals in the primary care setting rather than specific methodological keywords when most appropriate. The searches described below were therefore of comparatively low specificity.

Medline (1966-98), PsycInfo (1984-98), and embase (1980-98) were searched using the terms (family pract* OR general pract* OR primary care OR primary health care) AND (counsel* OR psychotherap* OR clin* psy* OR beh* therap* OR fam* therap* OR group therap* OR psychoanal* PR psychiat* OR cog* therap* OR psychodynam*)

The Cochrane controlled clinical trials register was searched using the terms:  ((primary near care) OR (general near pract*)
OR (fam* near pract*))AND (counsel* OR psychotherap* OR (clin* near psy*) OR (beh* near therap*) OR (fam* near therap*) OR (group near therap*) OR psychoanal* OR psychiat* OR (cog* near therap*) OR psychodynam*

The register of the effective practice and organisation of care group was searched using the terms:  primary (near) care (or) general (near) practitioner (or) general (near) practice (or) family (near) practice (or) family (near) practitioner (or) family (near) medicine and psychiat* (OR) psycho* (OR) mental* (OR) emot*

The Counselling in Primary Care Trust Counsel. Lit database was searched from 1980 using the search terms:  random OR meta OR trial OR effectiveness OR efficacy OR outcome OR control OR evaluation OR review OR comparative

Reference lists of all relevant studies

The reference lists of all relevant studies were searched for further studies

Searches were conducted between 18-22 June 1998. Papers of potential relevance that were identified after this date through means other than electronic database searching were added to the list of studies "awaiting assessment."

Excluded studies

Consultation-liaison studies

The following studies of consultation-liaison services were included in the full Cochrane review but were excluded from this particular paper: the review of these studies will be submitted elsewhere.

Gater R, Goldberg D, Jackson G, Jennett N, Lowson K, Ratcliffe J, et al. The care of patients with chronic schizophrenia: a comparison of two services. Psychol Med 1997;27:1325-36.

Goldberg D, Jackson G, Gater R, Campbell M, Jennett N. The treatment of common mental disorders by a community team based in primary care: a cost-effectiveness study. Psychol Med 1996;26:487-92.

Jackson G, Gater R, Goldberg D, Tantam D, Loftus L, Taylor H. A new community mental health team based in primary care: a description of the service and its effect on service use in the first year. Br J Psychiatry 1993;162:375-84.

Katon W, Von Korff M, Lin E, Walker E, Simon G, Bush T, et al. Collaborative management to achieve treatment guidelines: impact on depression in primary care. JAMA 1995;273:1026-31.

Von Korff M, Katon W, Bush T, Lin E, Simon G, Saunders K, et al. Treatment costs, cost offset, and cost effectiveness of collaborative management of depression. Psychosom Med 1998;60:143-9.

Katon W, Robinson P, Von Korff M, Lin E, Bush T, Ludman E, et al. A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry 1996;53:924-32.

Von Korff M, Katon W, Bush T, Lin E, Simon G, Saunders K, et al. Treatment costs, cost offset, and cost effectiveness of collaborative management of depression. Psychosom Med 1998;60:143-9.

Katon W, Von Korff M, Lin E, Bush T, Russo J, Lipscomb P, et al. A randomized trial of psychiatric consultation with distressed high utilisers. Gen Hosp Psychiatry 1992;14:86-9.

Katon W, Von Korff M, Lin E, Bush T, Ormel J. Adequacy and duration of antidepressant treatment in primary care. Med Care 1992;30:67-76.

Katon W, Von Korff M, Lin E, Bush T, Russo J, Lipscomb P, et al. A randomized trial of psychiatric consultation with distressed high utilisers. Gen Hosp Psychiatry 1992;14:86-9.

Lin E, Katon W, Simon G, Von Korff M, Bush T, Rutter C, et al. Achieving guidelines for the treatment of depression in primary care: is physician education enough? Med Care 1997;35:831-42.

Mann A, Blizard R, Murray J, Smith J, Botega N, MacDonald E, et al. An evaluation of practice nurses working with general practitioners to treat people with depression. Br J Gen Pract 1998;48:875-9.

Mann A, Blizard R, Murray J, Smith J, Botega N, MacDonald E, et al. An evaluation of practice nurses working with general practitioners to treat people with depression. Br J Gen Pract 1998;48:875-9.

Warner R, Gater R, Jackson M, Goldberg D. Effects of a community mental health team on the practice and attitudes of general practitioners. Br J Gen Pract 1993;43:507-11.

Wilkinson G, Allen P, Marshall E, Walker J, Browne W, Mann A. The role of the practice nurse in the management of depression in general practice: treatment adherence to antidepressant medication. Psychol Med 1993;23:229-37.

Direct non-randomised controlled before and after studies

Although eligible in reviews submitted under the effective practice and organisation of care group of the Cochrane Collaboration, all these studies were excluded from this article. This was because sufficient randomised controlled trials were found in the review: the interpretative difficulties associated with non-randomised studies thus outweighed their usefulness.

Basler H, Rehfisch H. Follow up results of a cognitive-behavioural treatment for chronic pain in a primary care setting. Psychol Health 1990;4:293-304.

Blakey R. Psychological treatment in general practice: its effect on patients and their families. J R Coll Gen Pract 1986;36:209-11.

Brantley P, Veitia M, Callon E, Buss R, Sias C. Assessing the impact of psychological intervention on family practice clinic visits. Fam Med 1986;18:351-4.

Lyon D. The evaluation of counselling in primary care. Health Direct 1997;30:11.

Anon. Can counselling bring benefits for all? Fundholding 1995;4:23-4.

Martin E, Martin P. Changes in psychological diagnosis and prescription in a practice employing a counsellor. Fam Pract 1985;2:241-3.

Other excluded studies

These studies were examined as potentially relevant but were excluded because they did not meet the definition of primary care, did not report objective measures of general practitioner behaviour, did not include a mental health professional (for example, studies of self help mental health treatments), involved psychological treatment in physical disorder (for example, health psychological studies); or failed specific quality criteria of the effective practice and organisation of care group (for example, less than two time periods preintervention and postintervention in an interrupted time series, non-contemporaneous controls in a controlled before and after study)

Appleby L, Warner R, Whitton A, Faragher B. A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ 1997;314:932-6.

Bannerjee S, Shamash K, MacDonald A, Mann A. Randomised controlled trial of effect of intervention by psychogeriatric team on depression in frail elderly people at home. BMJ 1996;313:1058-61.

Basler H, Brinkmeier U, Buser K, Haehn K, Molders-Kober R. Psychological group treatment of obese essential hypertensives by lay therapists in rural general practice settings. J Psychosom Res 1996;29:383-91.

Blackburn I, Moore R. Controlled acute and follow up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression. Br J Psychiatry 1981;171:328-34.

Blackburn I, Eunson K, Bishop S. A two-year naturalistic follow up of depressed patients treated with cognitive therapy, pharmacotherapy and a combination of both. J Affective Dis 1986;10:67-75.

Blowers C, Cobb J, Mathews A. Generalised anxiety: a controlled treatment study. Behav Res Ther 1987;25:493-502.

Brooker C, Falloon I, Butterworth A, Goldberg D, Graham-Hole V, Hillier V. The outcome of training community psychiatric nurses to deliver psychosocial intervention. Br J Psychiatry 1994;165:222-30.

Brown C, Schulberg H, Madonia M, Shear K, Houck P. Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. Am J Psychiatry 1996;153:1293-300.

Brown J, Cochrane R, Mack C, Leung N, Hancox T. Comparison of effectiveness of large scale stress workshops with small stress/anxiety management training groups. Behav Cognitive Psychother 1998;26:219-35.

Bruce J, Watson M, Watson D, Palin A, Lawton K. Workload implications of community psychiatric nurse employment by a general practice: a pilot study. Br J Gen Pract 1998;48:1419-20.

Busch C, Bartholomew J, Sharp D. Group treatment of anxiety and stress in a general practice setting. Primary Care Psychiatry 1996;2:59-67.

Butler G, Cullington A, Klimes I, Gelder M. Anxiety management for persistent generalised anxiety. Br J Psychiatry 1987;151:535-42.

Butler G, Fennell M, Robson P, Gelder M. Comparison of behaviour therapy and cognitive behaviour therapy in the treatment of generalised anxiety disorder. J Consult Clinical Psychol 1991;59:167-75.

Callahan C, Hendrie H, Dittus R, Brater D, Hui S, Tierney W. Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc 1994;42:839-46.

Carr V, Lewin T, Walton J, Faehrmann C, Reid A. Consultation-liaison psychiatry in general practice. Aust NZ J Psychiatry 1997;31:85-94.

Catalan J, Gath D, Bond A, Martin P. The effects of non-prescribing anxiolytics in general practice II. Factors associated with outcome. Br J Psychiatry 1984;144:603-10.

Catalan J, Gath D, Edmonds G, Ennis J. The effects of non-prescribing of anxiolytics in general practice I. Controlled evaluation of psychiatric and social outcome. Br J Psychiatry 1984;144:593-602.

Chalder T, Wallace P, Wessely S. Self help treatment of chronic fatigue in the community: a randomised controlled trial. Br J Health Psychol 1997;2:189-97.

Cooper B, Harwin B, Depla C, Shepherd M. Mental health care in the community: an evaluative study. Psychol Med 1975;5:372-80.

Cooper P, Murray L. The impact of psychological treatments of postpartum depression on maternal mood and infant development. In: Postpartum depression and child development. New York: Guildford Press, 1997;201-20.

Coulehan J, Schulberg H, Block M, Madonia M, Rodriguez E. Treating depressed primary care patients improves their physical, mental and social functioning. Arch Intern Med 1997;157:1113-20.

Cullen K. A six year controlled trial of prevention of children’s behaviour disorders. J Pediatrics 1976;88:662-6.

Donnan P, Hutchinson A, Paxton R, Grant B, Firth M. Self help materials for anxiety: a randomised controlled trial in general practice. Br J Gen Pract 1990;40:498-501.

Eayrs C, Rowan D, Harvey P. Behavioural group training for anxiety management. Behav psychother 1984;12:117-29.

Graves R, Hastrup J. Psychological intervention and medical utilisation in children and adolescents of low-income families. Profess Psychol 1981;12:426-33.

Hebert R, Leclerc G, Bravo G, Girouard D, LeFrancois R. Efficacy of a support group programme for caregivers of demented patients in the community: a randomized controlled trial. Arch Gerontol Geriatr 1994;18:1-14.

Hellman C, Budd M, Borysenko J, McClelland D, Benson H. A study of the effectiveness of two group behavioural medicine interventions for patients with psychosomatic complaints. Behav Med 1990;16:165-73.

Hemmings A, Cogan M. The non-pharmacological management of anxiety. Guildford: University of Sussex, 1993.

Hirsch T, Perry P, Hirsch S, Bagadia V, Pradhan P, Kumar R, et al. Effects of benzodiazepenes and counselling on minor psychiatric morbidity: report from a WHO collaborative study. WHO, 1997.

Holden J, Sagovsky R, Cox J. Counselling in the general practice setting: controlled study of health visitor intervention in the treatment of postnatal depression. BMJ 1989;298:223-6.

Holdsworth N, Paxton R, Seidel S, Thomson D, Shrubb S. Parallel evaluations of new guidance materials for anxiety and depression in primary care. J Ment Health 1996;5:195-207.

Horowitz C, Goldberg H, Martin D, Wagner E, Fihn S, Christensen D, et al. Conducting a randomized controlled trial of CQI and academic detailing to implement clinical guidelines. Jt Commission J Qua Improvement 1996;22:734-50.

Hunter M, Liao K. Problem solving groups for mid-aged women in general practice: a pilot study. J Reprod Infant Psychol 1995;13:147-51.

Jenkins D, MacDonald A. Should general practitioners refer more of their elderly patients to psychiatric services? Int J Geriatr Med 1994;9:461-5.

Karlberg L, Krakau I, Unden A. Type A behaviour intervention in primary care reduces hostility and time pressure: a study in Sweden. Soc Sci Med 1998;46:397-402.

Kashner M, Rost K, Smith R, Lewis S. An analysis of panel data: the impact of a psychiatric consultation letter on the expenditures and outcomes of care for patients with somatisation disorder. Med Care 1992;30:811-21.

Kashner M, Rost K, Cohen B, Anderson M, Smith G. Enhancing the health of somatization disorder patients. Psychosomatics 1995;36:462-70.

Rost K, Kashner M, Smith R. Effectiveness of psychiatric intervention with somatization disorder patients: improved outcomes at reduced costs. Gen Hosp Psychiatry 1994;16:381-7.

Kiely B, McPherson I. Stress self-help packages in primary care: a controlled trial evaluation. J R Coll Gen Pract 1986;307-9.

King M, Broster G, Lloyd M, Horder J. Controlled trials in the evaluation of counselling in general practice. Br J Gen Pract 1994;44:229-32.

Klerman G, Budman S, Berwick S, Weissman M, Damico-White J, Demby A, et al. Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care. Med Care 1996;25:1078-88.

Kupshik G, Fisher C. Assisted bibliotherapy: effective, efficient treatment for moderate anxiety problems. Br J Gen Pract 1999;49:47-8.

Lewis G, Sharp D, Bartholomew J, Pelosi A. Computerized assessment of common mental disorders in primary care: effect on clinical outcome. Fam Pract 1996;13:120-6.

Lidbeck J. Group therapy for somatisation disorders in general practice: effectiveness of a short cognitive-behavioural treatment model. Acta Psychiatry Scand 1997;96:14-24.

Lindsay W, Gamsu C, McLaughlin E, Hood E, Espie C. A controlled trial of treatments for generalised anxiety. Br J Clin Psychol 1987;26:3-15.

Lynch D, Tamburrino M, Nagel R. Telephone counseling for patients with minor depression: preliminary findings in a family practice setting. J Fam Pract 1997;44:293-8.

Marks I. Controlled trial of psychiatric nurse therapists in primary care. BMJ 1985;290:1181-4.

McKechnie A, Philip A, Ramage J. Psychiatric services in primary care: specialized or not? J R Coll Gen Pract 1981;31:611-4.

McLeod C, Budd M, McClelland D. Treatment of somatisation in primary care. Gen Hosp Psychiatry 1997;19:251-8.

Milne D, Covitz F. A comparative evaluation of anxiety management materials in general practice. Health Educ J 1988;47:67-9.

Milne D, Souter D. A re-evaluation of the clinical psychologist in general practice. J R Coll Gen Pract 1988;38:457-60.

Miranda J, Munoz R. Intervention for minor depression in primary care patients. Psychosom Med 1994;56:136-42.

Munoz R, Ying Y, Bernal G, Perez-Stable E, Sorensen J, Hargreaves W, et al. Prevention of depression with primary care patients: a randomized controlled trial. Am J Community Psychol 1995;23:199-222.

Mynors-Wallis L, Gath D, Lloyd-Thomas A, Tomlinson D. Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ 1995;310:441-5.

Nazareth I, King M, See Tai S. Monitoring psychosis in general practice: a controlled trial. Br J Psychiatry 1996;169:475-82.

O'Donnell J, Toseland R. Does geriatric evaluation and management improve the health behaviour of older veterans in psychological distress. J Aging Health 1997;9:473-97.

Onyett S, Turpin G. Benzodiazepene withdrawal in primary care: a comparison of behavioural group training and individual sessions. Behav Psychother 1988;16:297-312.

Paykel E, Mangen S, Griffith J, Burns T. Community psychiatric nursing for neurotic patients: a controlled trial. Br J Psychiatry 1982;140:573-81.

Power K, Jerrom W, Simpson R, Mitchell M, Swanson V. A controlled comparison of cognitive-behaviour therapy, diazepam and placebo in the management of generalised anxiety. Behav Psychother 1989;17:1-14.

Power K, Simpson R, Swanson V, Wallace A. Controlled comparison of pharmacological and psychological treatment of generalised anxiety disorder in primary care. Br J Gen Pract 1990;40:289-94.

Power K, Simpson R, Swanson V, Wallace L, Feistner A, Sharp D. A controlled comparison of cognitive-behaviour therapy, diazepam, and placebo, alone and in combination, for the treatment of generalised anxiety disorder. J Anxiety Disord 1990;4:267-92.

Raphael B. Preventive intervention with the recently bereaved. Arch Gen Psychiatry 1977;34:1450-4.

Ross M, Scott M. An evaluation of the effectiveness of individual and group cognitive therapy in the treatment of depressed patients in an inner city health centre. J R Coll Gen Pract 1985;35:239-42.

Rost K, Kashner M, Smith R. Effectiveness of psychiatric intervention with somatization disorder patients: improved outcomes at reduced costs. Gen Hosp Psychiatry 1994;16:381-7.

Saarijarvi S. A controlled study of couple therapy in chronic low back pain patients. Effects on marital satisfaction, psychological distress and health attitudes. J Psychosom Res 1991;35:265-72.

Saarijarvi S, Rytokoski U, Alanen E. A controlled study of couple therapy in chronic low back pain patients: no improvements in disability. J Psychosom Res 1991;35:671-7.

Schulberg H, Pilkonis P, Houck P. The severity of major depression and choice of treatment in primary care practice. J Consult Clin Psychol 1998;66:932-8.

Schulberg H, Block M, Madonia M, Scott P, Rodriguez E, Imber S, et al. Treating major depression in primary care practice: eight month clinical outcomes. Arch Gen Psychiatry 1996;53:913-9.

Scott A, Freeman C. Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ 1992;304:883-7.

Scott C, Tacchi M, Jones R, Scott J. Acute and one-year outcome of a randomised controlled trial of brief cognitive therapy for major depressive disorder in primary care. Br J Psychiatry 1997;171:131-4.

Smith G, Monson R, Ray D. Psychiatric consultation in somatization disorder. N Engl J Med 1986;314:1407-13.

Smith G, Rost K, Kashner M. A trial of the effect of a standardised psychiatric consultation on health outcomes and costs in somatising patients. Arch Gen Psychiatry 1995;52:238-43.

Sorby N, Reavley W, Huber J. Self help programme for anxiety in general practice: controlled trial of an anxiety management booklet. Br J Gen Pract 1991;41:417-20.

Trepka C, Laing I, Smith S. Group treatment of general practice anxiety problems. J R Coll Gen Pract 1986;36:114-7.

Tudiver F, Hilditch J, Permaul J, McKendree D. Does mutual help facilitate newly bereaved widowers? Eval Health Profess 1992;15:147-62.

Tudiver F, Permaul-Woods J, Hildritch J, Harmina J, Saini S. Do widowers use the health care system differently? Does intervention make a difference? Can Fam Physician 1995;41:392-9.

White J. "Stress control" large group therapy for generalised anxiety disorder: two year follow up. Behav Cognitive Psychoth 1998;26:237-45.

White J. "Stresspac": three year follow up of a controlled trial of a self help package for the anxiety disorders. Behav Cognitive Psychother 1998;26:133-41.

White J. Stresspac: a controlled trial of a self-help package for anxiety disorders. Behav Cognitive Psychother 1995;23:89-107.

Wickberg B, Hwang C. Counselling of postnatal depression: a controlled study on a population based Swedish sample. J Affective Disord 1996;39:209-16.

Williams P, Balestrieri M. Psychiatric clinics in general practice: do they reduce admissions? Br J Psychiatry 1989;154:67-71.

Wood K, Anderson J. The effect on hospital admissions of psychiatric case management involving general practitioners: preliminary results. Aust NZ J Psychiatry 1994;28:223-9.

Studies awaiting assessment

These studies could not be included or excluded on the basis of published information. Further information will be sought from the authors concerning specific issues. Studies that meet criteria will be included in later versions of the Cochrane review.

Bernal A, Fuste R, Urbieta R, Montesinos I. Relaxation therapy in primary care for patients with anxiety and somatoform disorders. [Spanish] Atencion Primaria 1995;15:499-504.

Blanchard M, Waterreus A, Mann A. The effect of primary care nurse intervention upon older people screened as depressed. Int J Geriatr Psychiatry 1995;10:289-98.

Finney J, Lemanek K, Cataldo M, Katz H, Fuqua R. Pediatric psychology in primary health care: brief targeted therapy for recurrent abdominal pain. Behav Ther 198;20:283-91.

Finney J, Riley A, Cataldo M. Psychology in primary health care: effects of brief targeted therapy on children’s medical care utilisation. J Pediatr Psychol 1991;16:447-61.

Friedli K, King M, Lloyd M, Horder J. Randomised controlled assessment of non-directive psychotherapy versus routine general-practitioner care. Lancet 1997;350:1662-5.

Friedli K, King M, Lloyd M. Randomised controlled assessment of counselling versus routine general practitioner care: cost minimisation analysis. Br J Gen Pract 2000;(in press)

Huygen F, Smits A. Family therapy, family somatics, and family medicine. Fam Sys Med 1983;1:23-32.

Jones D. Weaning elderly patients off psychotropic drugs in general practice: a randomised controlled trial. Health Trends 1990;22:164-6.

Kashner M, Rost K, Cohen B, Anderson M, Smith G. Enhancing the health of somatization disorder patients. Psychosomatics 1995;36:462-70.

Lave J, Frank R, Schulberg H, Kamlet M. Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry 1998;55:645-51.

Lofvander M, Engstrom A, Theander H, Furhoff A. Rehabilitation of young immigrants in primary care: a comparison between two treatment models. Scand J Primary Health Care 1997;15:123-8.

Neira-Munoz E, Ward D. Side by side. Health Serv J 1998;108:26-7.

O'Donnell J, Toseland R. Does geriatric evaluation and management improve the health behaviour of older veterans in psychological distress. J Aging Health 1997;9:473-97.

Patrick D, Eagle J, Coleman J Primary care treatment of emotional problems in an HMO. Med Care 1978;16(1):47-60.

Peveler R, George C, Kinmouth A, Campbell M, Thompson C. Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial. BMJ 1999;319:612-5.

Toseland R, O’Donnell J, Engelhardt J, Hendler S, Richie J, Jue D. Outpatient geriatric evaluation and management: results of a randomised trial. Med Care 1996;34:624-40.

Toseland R, O’Donnell J, Engelhardt J, Richie J, Jue D, Banks S. Outpatient geriatric evaluation and management: is there an investment effect. Gerontologist 1997;37:324-32.

Tyrer P, Seivewright N, Wollerton S. General practice psychiatric clinics: impact of psychiatric services. Br J Psychiatry 1984;145:15-9.

Tyrer P, Ferguson B, Wadsworth J. Liaison psychiatry in general practice: the comprehensive collaborative model. Acta Psychiatr Scand 1990;81:359-63.

Winkler R, Underwood P, Fatovich B, James R, Gray D. A clinical trial of a self-care approach to the management of chronic headache in general practice. Soc Sci Med 1989;29:213-9.

Ongoing studies

These are studies known to the author which may be of relevance to the review but are yet to report.

Ashworth M, Davies T, Ramsey R. Mental health workers in primary care and their impact on practice activity.

Chilvers C. A randomised controlled trial of counselling and antidepressants in primary care.

Corney R. A randomised controlled trial to evaluate the efficacy and cost-effectiveness of counselling with patients with chronic depression and anxiety.

Dowrick C. Outcomes of depression in Europe (ODIN)C psychological treatments.

King M. Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression and mixed anxiety and depression in primary care.

Simpson S, Corney R, Fitzgerald P. The relationship between counselling provision, prescribing and referral rates in a general practice setting.

Tyrer P. A randomised controlled trial of liaison psychiatry in general practice: a feasibility study.

Verduyn C. Depressed mothers and problem childrenC secondary prevention in primary care.
 

Table A  Randomised controlled trials of direct effects on consultation rates. Values are mean (SD) unless stated otherwise
 

Trial	No of doctors (practices*)	No of patients	Therapy	Outcome	Duration	Intervention v control	P value
Ashurst and Ward 198310	12 (2)	233	Counselling	Mean No of consultations and mean time (minutes) in consultation	12 months	7 v 6.3, 64 v 59	NR, 0.36
Boot et al 199411	28 (7)	167	Counselling	Consultations (%)	6 weeks	51 v 65	0.1
Stanton and Corney 199812	6*	40	Counselling	Consultations (%)	6 months	0-2, 3-4, 5, and missing respectively: 30, 22, 35, 13 v 46, 25, 12, missing 17	NR, NR
Gournay and Brooking 199413 199514	6*	92	Counselling by psychiatric nurse	No of consultations	6 months	3.34 (2.93) v 3.04 (2.84)	NS
Harvey et al 199815	9*	162	Counselling	Mean general practitioner time (hours) and mean cost (£)	4 months	0.63 v 1.50 (15.75 v 28.75)	NR, NR
Benson and Turk 198816	6 (1)	50	Group therapy by psychologist and general practitioner	No of consultations and mean No of consultations	6, 12, and 18 months and 24 months	2.9 (2.2) v 4.2 (3.0), 2.5 (1.6) v 3.2 (2.8), 1.5 (1.5) v 3.1 (2.5), and 1.6 v 3.0	NR, NR, <0.01, NR
Ginsberg et al 198417	20 (4 health centres)	42	Behaviour therapy by nurse therapist	Mean No of consultations, No of home visits, mean cost of general practitioner consultations (£)	12 months	4.4 v 7.0, 0.00 v 0.04, 6.27 v 9.10	All NR
Teasdale et al 198418	13*	34	Cognitive behaviour therapy by psychologist	Mean No of consultations	During treatment and3 months after treatment	0.51 v 1.07, 0.41 v 0.41	<0.05, NR
Earll and Kincey 198219	1*	42	Behaviour therapy by psychologist	Mean No of consultations	Discharge and 7 months	3.4 v 2.8, 5.6 v 5.2	NS, NS
Robson et al 198420	6 (1)	207	Behaviour therapy by psychologist	Consultations (%)	6 months	1-2, 3-4, and 5 respectively: 35, 20, 22 v 60, 40, 30	0.0008
Mynors-Wallis et al 199721	4 health centres	70	Problem solving by community nurse	No and cost of consultations (£)	2, 4, and 6 months	2.2 (1.8) v 2.3 (1.5), 2.8 (2.9) v 2.9 (2.9), 5.0 (4.1) v 5.1 (3.7), and 28.1 (22.9) v 29.3 (19.2), 36.2 (37.7) v 36.5 (37.5), 63.9 (52.0) v 65.2 (46.9)	0.844, 0.975, 0.914, and 0.844 0.975, 0.914
Catalan et al 199122	26 (16)	47	Problem solving by psychiatrist	Median No of consultations	4, 5-10, and 11-28 weeks	3 v 2, 2 v 3, 1 v 3	All NR
Corney 198423	7 (3)	80	Casework by social worker	Consultations	12 months	No data presented	NS

NR=not reported; NS=not significant.

When sample sizes on which general practitioner behaviour was based was unclear from report, total sample size at baseline (maximum possible sample size) was included.
 

Table B  Randomised controlled trials of direct effects on prescribing behaviour for psychotropics. Values are percentages unless stated otherwise
 

Trial	No of doctors (practices*)	No of patients	Therapy	Outcome	Duration	Intervention v control	P value
Ashurst and Ward 198310	12 (2)	134 and 96	Counselling	Tranquillisers and antidepressants	12 months	14.5 v 31.9, 17.1 v 18.2	0.03, 1.0
Boot et al 199411	28 (7)	167	Counselling	Psychotropics, antidepressants, anxiolytics	6 weeks	16 v 32, 9 v 23, 9 v 8	0.03, 0.02, 0.28
Stanton and Corney 199812	6*	40	Counselling	Psychotropics	6 months	22 v 33	NR
Hemmings 199724	15 (3)	188	Counselling	Psychotropics	4 and 8 months	20 v 33, 15 v 21	0.09, 0.8
Gournay and Brooking 199413 199514	6*	95	Counselling by psychiatric nurse	Psychotropics	24 weeks	18 v 24	NR
Corney 198423	7 (3)	80	Casework by social worker	Psychotropics	6 months	22 v 31	NS
Brodaty and Andrews 198325	10*	38	Dynamic therapy by psychiatrist	Mean (SD) prescribing of psychotropics	During treatment and 12 months after treatment	0.94 (0.87) v 0.50 (0.69), 0.75 (0.86) v 0.40 (0.60)	NR, NR
Teasdale et al 198418	13*	34	Cognitive behaviour therapy by psychologist	Antidepressants	During treatmentand 3 months after treatment	35 v 35, 35 v 29	NR, NR
Earll and Kincey 198219	1*	42	Behaviour therapy by psychologist	Psychotropics	Discharge and 7 months	39 v 74, 65 v 74	<0.05, NS
Robson et al 198420	6 (1)	429	Behaviour therapy by psychologist	Mean cost (£) of psychotropics	3, 6, and 12 months	2.00 v 4.10, 3.77 v 6.34, 5.63 v 9.69	0.004, 0.02, 0.01
Mynors-Wallis et al 199721	4 health centres	70	Problem solving by community nurse	Mean (SD) cost of drugs	8 weeks, 4 months, and overall	3.8 (9.0) v 6.8 (11.9), 2.5 (6.6) v 13.3 (23.3), 6.4 (12.8) v 20.1 (31.7)	0.25, 0.01, 0.02
Catalan et al 199122	26 (16)	47	Problem solving by psychiatrist	Psychotropics (proportion)	10 and 28 weeks	1/21 v 5/26, 0/21 v 4/26	NR, NR

NR=not reported; NS=not significant.
 

Table C  Randomised controlled trials of direct effects on mental health referrals. Values are percentages unless stated otherwise
 

NR=not reported; NS=not significant.
 

Table D  Controlled "before and after" trials on indirect effects of prescribing behaviour for psychotropics
 

Trial	No of practices	Therapy	Outcomes	Duration	Results	P value
Baker et al 199626 199827	30 matched	Counsellors*: 1-2 sessions to full time	Prescribing rates for anxiolytics and hypnotics and antidepressants	16 months pre and post	Tables reported only	0.56, 0.89
Pharoah 199628	32	Counsellors: No data on amount of provision	Prescription rates†	6 months pre and post	19.93 v 20.71, 18.97 v 19.32	0.30, 0.61 (change)
Coe et al 199629	Not clear	Counsellors: No data on amount of provision	Prescribing costs for hypnotics or antidepressants (£)	12 months pre and post	0.66 v 0.71, 0.55 v 0.55, and 1.64 v 2.09, 2.73 v 2.89	0.6, 0.07

*Description of mental health professionals as counsellors in indirect studies is likely to encompass a large variety of mental health professionals rather than specific professional group.

†Mean monthly items per 1000 prescribing units.
 

Table E  Controlled "before and after" trials of indirect effects on mental health referrals
 

Trial	Doctor sample	Therapy	Outcome measures	Duration	Results	P value
Coe et al 199629	Not clear	Counsellors: no data on amount of provision	Referral to psychiatry or mental health team per 1000 population	12 months pre and post and 12 months post	6.18 v 4.62, 5.84 v 7.61, 7.15 v 12.60	All NR
Baker et al 199626 199827	73 practices	Counsellors: 1-2 sessions to full time	Referral rates for: psychiatric outpatients, psychiatric inpatients, group therapy, occupational therapy, community psychiatric nurse, and psychology	12-18 months pre and post	Tables only	0.10, 0.94, 0.69, 0.43, 0.33, 0.05
Baker et al 199626 199827	Subsample of 26 matched practices from study above	Counsellors: 1-2 sessions to full time	Same referral rates as above			All NS
Walker et al 198930	2 towns	Counselling service: no data on amount of provision	Referral rates for outpatients (%) and inpatients	Both 12 months pre and post	0.13 v 0.29, 0.18 v 0.17, and 0.10 v 0.19, 0.31 v 0.15	All NR
Tarrier and Woof 198331	2 matched health centres and 2 matched practices	Psychologists: one session per week	Referral rates for practice and health centre	Both 24 months pre and post	56 v 159, 57 v 215, and 162 v 144, 203 v 142	All NR
Hunter and McCance 198332	2 sets of 2 matched practices	Psychiatric clinics: fortnightly	Referral rates for practices 1 and 2	12 months pre and post and 24 months post, and 12 months pre and post	6.4 v 3.9, 6.3 v 4.3, 5.3 v 5.4, and 7.5 v 7.5, 10.3 v 5.6	<0.05, NS, NS, and NR, NR

NR=not reported; NS=not significant.