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UKE Paper of the Month March 2024

Clinical effectivenes of patient-targeted feedback following depression screening in general parctice (GET.FEEDBACK.GB): An investigator-initiated, prospective, mulitcentre, three-arm, observer-blinded, randomised controlled trial

Bernd Löwe,* Martin Scherer,* Lea-Elena Braunschneider, Gabriella Marx, Marion Eisele, Tina Mallon, Antonius Schneider, Klaus Linde, Christine Allwang, Stefanie Joos, Stephan Zipfel, Sven Schulz, Liliana Rost, Katja Brenk-Franz, Joachim Szecsenyi, Christoph Nikendei, Martin Härter, Jürgen Gallinat, Hans-Helmut König, Alexander Fierenz, Eik Vettorazzi, Antonia Zapf, Marco Lehmann,† Sebastian Kohlmann† (* The two first authors contributed equally. † The two last authors contributed equally.)

ABSTRACT:

Backround:
Screening for depression in primary care alone is not sufficient to improve clinical outcomes. However, targeted feedback of the screening results to patients might result in beneficial effects. The GET.FEEDBACK.GP trial investigated whether targeted feedback of the depression screening result to patients, in addition to feedback to general practitioners (GPs), leads to greater reductions in depression severity than GP feedback alone or no feedback.

Findings:
Between July 17, 2019, and Jan 31, 2022, 25 279 patients were approached for eligibility screening, 17 150 were excluded, and 8129 patients completed screening, of whom 1030 (12·7%) screened positive for depression. 344 patients were randomly assigned to receive no feedback, 344 were assigned to receive GP-targeted feedback, and 339 were assigned to receive GP-targeted plus patient-targeted feedback. 252 (73%) patients in the no feedback group, 252 (73%) in the GP-targeted feedback group, and 256 (76%) in the GP-targeted and patient-targeted feedback group were included in the analysis of the primary outcome at 6 months, which reflected a follow-up rate of 74%. Gender was reported as female by 637 (62·1%) of 1025 participants, male by 384 (37·5%), and diverse by four (0·4%). 169 (16%) of 1026 patients with available migration data had a migration background. Mean age was 39·5 years (SD 15·2). PHQ-9 scores improved for each group between baseline and 6 months by -4·15 (95% CI -4·99 to -3·30) in the no feedback group, -4·19 (-5·04 to -3·33) in the GP feedback group, and -4·91 (-5·76 to -4·07) in the GP plus patient feedback group, with no significant difference between the three groups (global p=0·13). The difference in PHQ-9 scores when comparing the GP plus patient feedback group with the no feedback group was -0·77 (-1·60 to 0·07, d=-0·16) and when comparing with the GP-only feedback group was -0·73 (-1·56 to 0·11, d=-0·15). No increase in suicidality was observed as an adverse event in either group.

Statement:
Using a 3-arm randomised design, the GET.FEEDBACK.GP trial was the first to show the effectiveness of depression screening combined with different forms of feedback to physician and patient on depression severity, treatment initiation, physician-patient communication and adverse events. Thefindings indicate that direct feedback about depression screening results to the patient and the general practitioner (GP) has a greater impact than providing feedback to the treating GP alone or providing no feedback at all. GET.FEEDBACK.GP also provided evidence on which groups may or may not benefit from depression screening. This study will have implications for international guidelines on depression screening and provision of feedback in primary care, most of which recommend screening without evidence.

Lancet Psychiatry 2024

Congratulations to all authors!

Next PoM: To apply, the publication must have been published in March 2024. Applications will be considered in two rounds of the selection process, i.e. two months. Please send your completed PoM application to Dr. Anne Wulf by 30/04/2024.