OP150 An evaluation of a holistic intervention to reduce depression and increase physical activity in general practice

Background

Depression is the most common psychiatric disorder and is estimated to affect 280 million people worldwide. Patients with depression living in areas of higher economic deprivation are more likely to have additional long-term conditions compared to those in less deprived areas. The prevalence of depression amongst adult patients in a GP surgery in an area of deprivation in North East England is 17.6% which is significantly higher than the England average of 11.6%. Management strategies have traditionally focussed on counselling and anti-depressant medication, although evidence also suggests the role of physical activity (PA). Social Prescribing, developed from recognition that a person’s health and wellbeing is mostly determined by social, environmental and economic factors, supports individuals by helping them to take greater control of their health, and allowing referral to a variety of non-clinical services in the local area.

Aim

To evaluate the impact of a specifically designed home-based holistic intervention to increase physical activity and reduce depression.

Methods

The study employed a quasi-experimental design to evaluate percentage change scores in the outcome measures between baseline and post intervention (12 weeks). Two GPs, a social prescribing link worker (SPLW) and a consultant in Public Health designed a 12-week programme called Invigorate that focussed on using a holistic approach in order to reduce depression severity. Invigorate was based around physical activity interventions, but it also placed a strong emphasis on wider health determinants such as housing, debt and employment. Baseline and post-intervention Patient Health Questionnaire-9 (PHQ-9), GP Physical Activity Questionnaire (GP PAQ) scores and consultation activity metrics were compared.

Results

11 patients completed all six sessions. Average PHQ-9 was 15.4 at baseline and 6.9 at completion for the 8 patients who submitted initial and final questionnaires. This represents an average reduction of 55% in depression severity. 62% of patients improved their activity levels. The main issues identified at baseline included low mood, stress, debt and unemployment. The average number of mental health consultations in the six months leading up to the start of Invigorate was 2.45 per patient compared to 0.73 consultations per patient post-Invigorate. For non-mental health consultations these figures were 2.2 and 0.9, respectively.

Conclusion

A 12-week programme led by the SPLW focussing on physical activity led to improvements in depression severity and a reduction in the number of mental health and non-mental health GP consultations. Long term follow-up is planned for one year with findings informing the development of a larger scale study.