Depression is one of the most commonly diagnosed psychological conditions, and researchers continue to search for effective ways to address this problem. This study, conducted at nine sites across Europe, examined the effectiveness of two different psychological treatments for depression that can be readily employed in a wide variety of healthcare settings.

The first - called "problem solving treatment" - examined the relationship between problems (e.g. interpersonal conflicts or financial difficulties) and symptoms of depression (e.g. fatigue or a lack of pleasure in normally enjoyable activities). The idea behind this approach is that life's problems contribute toward depression. Thus, by taking concrete steps toward solving these problems, the depression should also improve.

The other treatment - called "group psycho-educational treatment" (short for psychological education) - consisted of teaching participants ways to effectively relax, think more positively and improve their social skills. The idea behind this approach is that depression results - in part - due to a lack of information and skills. When people learn ways to more effectively relax or improve their interpersonal skills, they reduce their distress, and thereby reduce the likelihood of getting depressed.

452 individuals with symptoms of depression participated in the study. They were identified through surveys of rural and urban communities. The study participants ranged in age from 18 to 65 years, with half of the participants being over the age of 45. Two thirds of the participants were women, and approximately one fourth of the participants were taking antidepressant medication at the time of the study.

Participants were randomly assigned to one of three groups:

• Group 1 was the Problem Solving treatment and consisted of six individual sessions, which in total, involved fewer than four hours of the therapists time. The sessions were conducted in private, either in a health care setting or in the participant's house. 128 participants were in this group.
• Group 2 was the Psychological Education treatment and consisted of eight presentations of 2.5 hours duration, during an eight-week course on preventing depression, carried out in a classroom-like setting. 108 participants were in this group.
• Group 3 consisted of 189 participants who received no treatment. This group served as the basis for comparison of the effectiveness of the other two groups.

The researchers looked at the acceptability of treatment and improvement in depression symptoms at six and twelve months after treatment ended. Acceptability was measured by the percentage of participants who completed either the problem solving or psychological education programs.

Improvement in treatment was measured with the use of three established questionnaires: the Beck Depression Inventory¹, a widely used questionnaire to measure of depression; the SF-36², a survey that asked participants about how well they felt they were functioning; and a survey by the World Health Organization³that seeks to determine the presence of depression.

Nearly two-thirds of people assigned to the problem solving treatment (group 1) finished the program. In comparison, only one half of the participants assigned to the education program (group 2) completed it.

At six-month follow-up, persons in both groups 1 and 2 showed an improvement in symptoms of depression, in comparison to those who received no treatment (group 3). Measures of depression, as assessed by the questionnaires, were significantly better for people in group 1 as compared to those in group 2. However, the findings suggest that in general, even if there were no dramatic improvements in depression symptoms, the people receiving some kind of treatment thought they were feeling better than those people who received no psychological treatment whatsoever.

People in both groups 1 and 2 reported that they were functioning better than those in group 3 (who received no psychological treatment). Improvements in functioning were still noticeable 12 months later for those persons in the problem solving group (group 1).

At six months follow-up, participants in the problem solving treatment group (group 1) were 17% less likely to qualify for a depression diagnosis than those receiving no treatment (group 3). Likewise, those in the psychological education group (group 2) were 14% less likely to qualify for a diagnosis of depression. However, these improvements were not noticeable at one year follow-up.

This study demonstrated that psychologically-oriented depression treatments can be implemented in a broad range of community settings, which typically serve a wide variety of individuals. While the problem solving intervention was more popular than the classroom-based psychological education course, that could have resulted from the appeal of having it delivered privately at one of the study sites, or in the privacy of participant's homes, rather than in an open classroom setting.

The authors suggest that the psychological program may have been less acceptable to people who are uncomfortable in public situations, because it was offered in a classroom-like setting. They add that, particularly in rural areas, a classroom-based program may be less desirable to people in small communities where people know each other. They may be reluctant to admit having emotional problems, especially if they feel that there is stigma attached to this.

Comments

Depression is quite common in the population, but often goes untreated. Thus, researchers are looking at ways to fill this gap. Because depression is complex, the choice of treatment has to be made on an individual basis. Health care providers and patients have to chose between pharmacological treatment only, psychological treatment only, or a combination of both.

For those in need of psychological treatment (either alone or in combination with medications), this study provides further evidence of the utility of both problem solving and psychological education approaches to improving a depressed person's condition.

Furthermore, in an era of cost-consciousness, this study offers evidence that programs can be brief, easily delivered, and still produce effective results (i.e. a reduction of the severity and duration of depressive disorders, as well as improvements in subjective mental and social functioning).