In Germany alone, nine and a half million people suffer from depression, half of them for a long time. Sufferers often experience treatment with large gaps. Many services, from GPs to psychotherapists, are not coordinated or sometimes not offered at all. The question being discussed in psychiatry and general medicine alike is: how can patients be supported safely and successfully in their illness so that they can possibly achieve better relief?
One possibility is disease management programs in which the family doctor plays a leading role. DMPs are treatment programs for chronic diseases. Diagnosis and treatment are carried out in one go, all specialists pull together with the patient, all important steps and tasks are carried out in a well-coordinated package. DMPs already exist in Germany for physical illnesses such as type 2 diabetes or asthma. Such a structured treatment program has not yet been established for depression in Germany, although it has "proven itself in international studies," says Schillok, "the data show that symptoms can be significantly improved."
However, such programs consist of many different components and are designed by many actors who work around the family doctor: medical assistants, supervising psychotherapists or psychiatrists and also lay people such as a patient's family and friends. In order to make a disease management program for depression more attractive, the question arises: Which of the many components that make up such measures internationally are particularly effective?
The Munich researchers and their colleagues examined this question in a so-called meta-analysis with individual patient data. The team looked at 35 studies and more than 20,000 patients in which the effect of collaborative care - with a wide variety of components - was compared with standard care for adult patients with depression in primary care. They looked closely at how the DMP was structured: How many participants were involved? What tasks do the stakeholders take on? Whether the family is involved? Whether technology is also used for patient contact? Which psychotherapeutic interventions were used in practice? And so on.
According to the new study, two components stand out. Firstly, and surprisingly for the experts: the involvement of friends and family. This means educating the people close to the depressed patient. The aim is to enable them to deal with the patient better, support them outside the doctor's surgery and motivate them to continue participating in the DMP. "And that," explains Schillok, "often works very well." Secondly: brief psychological interventions by the GP themselves. They usually last 20 to 40 minutes per session. Beforehand, the GP is guided by a therapist and is given various toolkits and manuals and, according to Schillok, "knows exactly which exercises and which steps to take in each session."
Efforts are currently underway in Germany to launch a new DMP for depression. "The findings of our study," says Hannah Schillok, "could help with the concrete design of the program."
The project took place as part of the DFG-funded research training group "POKAL" (DFG-GRK 2621).
