Management of common mental disorders in primary care

One major theme of the work within the Centre is the management of the common mental disorders of depression and anxiety in primary care  (Leads: Professor David KesslerProfessor Nicola Wiles). There are a number of strands to this work. We have an interest in the clinical and cost-effectiveness of interventions for individuals whose depression has not responded to treatment with antidepressants (MIR and CoBalT). We are applying new technologies to increase the efficiency of, and widen access to, cognitive behavioural therapy (CBT) and have developed an integrated model of CBT using online materials and live therapists online (INTERACT). A multi-centre trial began in 2020. As part of our work within the NIHR Bristol Biomedical Research Centre (BRC), we are exploring ways of translating findings from basic cognitive science to help us understand the mechanisms underlying psychological interventions. We are also undertaking research focussed on the identification, diagnosis and management of anxiety disorders in primary care.

People

David Kessler, Nicola Wiles, Debbie Tallon, Laura Thomas, Vivien Jones, Yeni Adewoye, Alison Burns, Sean-James Fallon, Narinder Bansal, Charlotte Archer, Lynsey Hall

Selected Publications

  • Archer C, Turner K, Kessler D, Mars B, Wiles N. Trends in the recording of anxiety in UK primary care: a multi-method approach. Social Psychiatry and Psychiatric Epidemiology (2021). https://doi.org/10.1007/s00127-021-02131-8 
  • Archer C, Kessler D, Wiles N, Turner K. GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study. British Journal of General Practice (2021) DOI: https://doi.org/10.3399/BJGP.2020.0959
  •  Stawarz K, Preist C, Tallon D, Thomas L, Turner K, Wiles N, Kessler D, Shafran R, Coyle D. Integrating the digital and the traditional to deliver therapy for depression: lessons from a pragmatic study. CHI 2020: Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems April 2020 Pages 1–14 https://doi.org/10.1145/3313831.3376510
  •  Lewis G, Duffy L, Ades A, Amos R, Araya R, Brabyn S, Button KS, Churchill R, Derrick C, Dowrick C, Gilbody S, Fawsitt C, Hollingworth W, Jones V, Kendrick T, Kessler D, Kounali D, Khan N, Lanham P, Pervin J, Peters TJ, Riozzie D, Salaminios G, Thomas L, Welton NJ, Wiles N, Woodhouse R, Lewis G. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration: a pragmatic randomised controlled trial. Lancet Psychiatry (2019) https://doi.org/10.1016/S2215-0366(19)30366-9
  • Davies P, Ijaz S, Williams CJ, Kessler D, Lewis GH, Wiles NJ. Pharmacological interventions for treatment-resistant depression in adults. Cochrane Database of Systematic Reviews (2019) Issue 12 Art No.: CD010557. https://doi.org/10.1002/14651858.CD010557.pub2 
  • Barnes M, Archer C, Kessler D, Wiles N. Prioritising physical and psychological symptoms: what are the barriers and facilitators to the discussion of anxiety in the primary care consultation? Family Practice (2019) 20: 106. 
  • Taylor A, Tallon D, Kessler D, Peters TJ, Shafran R, Williams C, Wiles N. An expert consensus on the most effective components of cognitive behavioural therapy for adults with depression: a modified Delphi study. Cog. Behav. Ther. (2019) 20:1-14 doi: 10.1080/16506073.2019.1641146 
  • López-López JA, Davies SR, Caldwell DM, Churchill R, Peters TJ, Tallon D, Dawson S, Wu Q, Li J, Taylor A, Lewis G, Kessler DS, Wiles N, Welton NJ. The process and delivery of CBT for depression in adults: A systematic review and network meta-analysis. Psychological Medicine (2019) DOI: https://doi.org/10.1017/S003329171900120X
  • Tallon D, McClay CA, Kessler D, Lewis G, Peters TJ, Shafran R, Williams C, Wiles N. Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views. Cognitive Behav. Ther. (2018) DOI: 10.1080/16506073.2018.1541927
  • Kessler DS, MacNeill SJ, Tallon D, Lewis G, Peters TJ, Hollingworth W, Round J, Burns A, Chew-Graham CA, Anderson IM, Shepherd T, Campbell J, Dickens CM, Carter M, Jenkinson C, Macleod U, Gibson H, Davies S, Wiles NJ. Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: a placebo controlled randomized trial (MIR). BMJ (2018) 363 doi: https://doi.org/10.1136/bmj.k4218 
  • Wiles N, Taylor A, Turner N, Barnes M, Campbell J, Lewis G, Morrison J, Peters TJ, Thomas L, Turner K, Kessler D. Management of treatment resistant depression in primary care: a mixed methods study. Br.J.Gen.Pract. (2018)  68 (675): e673-e681.
  • Ijaz S, Davies P, Williams CJ, Kessler D, Lewis G, Wiles N. Psychological therapies for treatment-resistant depression in adults. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD010558. DOI: 10.1002/14651858.CD010558.pub2.
  • Davies, S. R., Caldwell, D. M., Lopez-Lopez, J. A., Dawson, S., Wiles, N., Kessler, D., Welton, N. J. & Churchill, R. The process and delivery of cognitive behavioural therapy (CBT) for depression in adults: A network meta-analysis.Cochrane Database of Systematic Reviews. 2018, 10, 16 p., CD013140.
  • French L, Thomas L, Campbell J, Kuyken W, Lewis G, Williams C, Wiles NJ, Turner KM. Individuals’ long term use of cognitive behavioural skills to manage their depression: a qualitative study. Behav Cog Psychother (2017) 45 (1): 46-57. 

Current Grants

  • Wiles N, Kessler D, Welton N, Wevill C, Coyle D, Turner K, Churchill R, Parrott S, Williams C, Lewis G, Nazareth I, Shafran R, Gilbody S, Peters T, Macleod U, Lanham P.  Integrated therapist and online CBT for depression in primary care.  NIHR Programme Grant for Applied Research.  £2,523,536.  2016 – 2024

This programme of work is developing and evaluating a novel approach to delivering cognitive behavioural therapy that integrates online CBT materials and input from an accredited therapist.

  •  Penton-Voak I, Fallon S-J, Kessler D, Wiles N, Munafò M. fMRI investigation of the neural mechanisms of Emotional Cognitive Bias Modification as an adjunct therapy to SSRIs in depression. MRC Experimental Challenge Grant. £595,105. 2019 – 2022 

This study is investigating whether a psychological therapy that improves the way we see emotion in others could improve the efficacy of antidepressants.

  • Bansal N, Malpass A, Chew-Graham C, Dowrick C, Wiles N, Kessler D, Cohen R. Understanding ethnic inequities in pathways to mental health services: A meta-ethnography of perceptions and experiences of people from ethnic minority groups. NIHR Research for Patient Benefit (RfPB) £147,118. 2020 – 2021. 

The aim is to develop a new conceptual understanding of how help-seeking for symptoms of mental illness is perceived, negotiated and experienced by different ethnic groups.

  • Bansal N, Kessler D, Wiles N, Payne R. Antidepressant use and risk of morbidity and mortality: a population-based cohort study. NIHR School for Primary Care Research. £48,332. 2018-2021. 

Using data from UK Biobank this secondary analysis will examine the long-term effects of antidepressant treatment.

  • Barnes M, Kessler D, Wiles N. Exploring barriers and facilitators to identifying anxiety disorders in primary care. NIHR School for Primary Care Research. £72,178. 2017-2019. 

In this study, semi-structured interviews with GPs and patients, alongside video-recordings of GP consultations will be used to understand the factors acting as barriers and facilitators to the identification of anxiety disorders in primary care.

  • Lewis G, Nazareth I, King M, Kessler D, Gilbody S, Freemantle N, Hunter R, Kendrick A, Moore M, Wiles N. Antidepressants to prevent relapse in depression. NIHR Health Technology Assessment Programme. £1,668,028. 2016-2020 

This multi-centre trial is evaluating the clinical and cost-effectiveness of continuing on long-term maintenance antidepressants compared with placebo in preventing relapse of depression in UK primary care.

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