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Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial

BMJ 2000; 321 doi: (Published 09 December 2000) Cite this as: BMJ 2000;321:1450
  1. Christopher Dowrick, professor (cfd{at},
  2. Graham Dunn, professor of biomedical statisticsb,
  3. Jose Luis Ayuso-Mateos, professorc,
  4. Odd Steffen Dalgard, professor of social psychiatryd,
  5. Helen Page, research fellowa,
  6. Ville Lehtinen, research professore,
  7. Patricia Casey, professor of adult psychiatryf,
  8. Clare Wilkinson, professorg,
  9. Jose Luis Vazquez-Barquero, professorc,
  10. Greg Wilkinson, professor of liaison psychiatryh
  1. a the Outcomes of Depression International Network (ODIN) GroupDepartment of Primary Care, University of Liverpool, Liverpool L69 3GB,
  2. b School of Epidemiological and Health Sciences, University of Manchester, Manchester M13 9PT,
  3. c Unit for Research into Social Psychiatry, University Hospital ‘Marques de Valdecilla,’ 39008 Santander, Spain,
  4. d Institute of General Practice and Community Medicine, University of Oslo, PO Box 1130, Blindern, N-0317 Oslo, Norway,
  5. e STAKES Mental Health Research and Development Group, Mestarinkatu 2D, FIN-20810 Turku, Finland,
  6. f Mater Misericordiae Hospital, University College Dublin, Dublin 7, Ireland,
  7. g Division of General Practice, University of Wales College of Medicine, Wrexham LL13 7YP,
  8. h Department of Psychiatry, University of Liverpool, Liverpool L69 3BX
  1. Correspondence to: C Dowrick
  • Accepted 15 August 2000


Objectives: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function.

Design: A pragmatic multicentre randomised controlled trial, stratified by centre.

Setting: Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom.

Participants: 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

Interventions: Six individual sessions of problem solving treatment (n=128), eight group sessions of the course on prevention of depression (n=108), and controls (n=189).

Main outcome measures: Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function.

Results: 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was −2.63 (95% confidence interval −4.95 to −0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was −1.50 (−4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome.

Conclusions: When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.


  • Funding The project for the outcomes of depression international network was supported by the EC Biomed 2 programme (contract No BMH4-CT-1681), the English National Health Service Executive north west research and development office (contract No RDO/18/31), Spanish Fondo de Investigacion Sanitaria (contract No 96/1798), the Wales office of research and development (contract No RC092), the Norwegian Research Council, the Council for Mental Health, the Department of Health and Social Welfare, and the Finnish Pensions Institute of Agricultural Entrepreneurs (contract No 0339).

  • Conflict of interest None declared.

  • Accepted 15 August 2000
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