Mental health prevention and promotion in general practice settings: A feasibility study

Abstract

Background
Mental health problems are typically addressed and intervened through a reactive approach rather than a proactive or preventative one. The aim of this feasibility RCT was to explore the possibility of recruiting to, and delivering a brief psychological intervention, focusing upon mental health prevention and promotion, in General Practice (GP).

Methods
This was a two-arm feasibility study where participants were randomised to either: treatment-as-usual (TAU) from their General Practitioner; or to a brief psychological intervention. Sixty-four participants, aged 16 and over, from 10 GP surgeries, with mild to moderate mental health difficulties, as measured by the PHQ9 and GAD7, were recruited. Intervention engagement data were summarised utilising descriptive statistics. Descriptive statistics were used to summarise clinical outcome measures at baseline and follow-up and to informally compare the two groups. Cost-effectiveness was investigated using descriptive statistics to analyse the resource use of participants and Health-Related Quality of Life (HRQoL). Qualitative data were analysed through thematic analysis and interpret in relation to Normalisation Process Theory, to understand implementation processes and the intervention's mechanism of change (facilitators and barriers).

Results
The recruitment target was met within the set timeframe. 230 patients were screened for eligibility, 72 of which were eligible and 64 were randomised. 80 % were female and 91.5 % identified as being white British. 19 dropped out, 9 of which were in the intervention arm and 10 from the TAU arm. The most frequent reason was reported as, no longer requiring support or being uncontactable. Clinical outcome measures were completed and demonstrated sensitivity to change. No participant safety factors were reported which would limit a larger trial and health economic data was collated. All of the progression criteria were classified as ‘amber’ meaning that progression to a definitive randomised controlled trial is warranted but modifications to improve recruitment, intervention engagement and participant retention is needed. Qualitative feedback was generally positive, with participants noticing therapeutic benefit, commenting on the ease of access and General Practitioners found the offer fitted well within GP.

Discussion
As a feasibility trial, the results demonstrate that individuals in GP can be recruited to a trial focusing upon the delivery of a brief psychological intervention and the required clinical assessments to assess effectiveness can be obtained. Qualitative feedback was positive from participants and GP staff and early indications seemed to demonstrate an improvement in wellbeing and a reduction in anxiety and depression. However, modifications for a larger trial are recommended to enhance recruitment and retention.