This randomised controlled trial explores whether debt advice provided by Citizens Advice Bureau (CAB) counsellors for patients with debt and depression, accessed through general practices, makes a difference to their recovery. This project is funded by the NIHR Health Technology Assessment Programme.
Depression and associated anxiety are common among patients seen in general practices. Many such patients also have debt and prolonged absence from work. There is increasing evidence of a relationship between indebtedness, depression and risk of self-harm and suicide.
Recognising this link, the UK government provides web-based advice and guides on debt-management highlighting a range of providers. Topping this list is the Citizens Advice Bureau (CAB), a charity-based service which is widely available across the UK in over 3,500 locations, providing support to over 2 million people per year. Unfortunately, people with depression, particularly those from socio-economically deprived groups, may be particularly likely to find on-line services insufficient or inaccessible (due to travel costs and/or low mood). As a result, a locally accessible, nationally provided advice service may be an important alternative.
The DeCoDer trial intervention brings together two existing services:
This intervention combines social, psychological, environmental, economic and medical perspectives in a formulation which incorporates personal goals and a bio-psycho-social management plan.
The study aims to determine the clinical and cost effectiveness of the addition of a Primary Care debt counselling advice service to usual care, to provide enhanced access to timely support for people with depression and debt.
Patients with a history of depression (with or without anxiety) within the last 12 months and who are worried about personal debt will be recruited through participating GP practices at the study sites. Follow the project's progress on the Plymouth University DeCoDer webpage.
Set up phase
This phase will include detailed theoretical modelling of the intervention based upon existing research available on collaborative care and social prescribing, supported by knowledge from the evaluation of the Liverpool CAB primary pilot.
First phase: Months 1-4
The intervention will be implemented in one GP practice per study site with 5-10 patients taking part at each site, focussing on use of the joint formulation. Detailed quantitative and qualitative process data will be collected using telephone and face-to-face interviews at each site and data recorded by the CAB workers in each practice. The model will be refined and manualised and a training programme developed for CAB workers and GPs. Organisational agreements and fidelity assessment procedures will also be developed.
Feasibility trial and review: Months 4-15
The intervention will be implemented utilising the manuals, training and organisational agreements developed during the first phase. Fidelity will be assessed and qualitative interviews will be used incorporating the Normalisation Process Theory to assess implementation problems and facilitators and resolve these to ensure the intervention is implemented as closely to the model as possible.
Refinements to training and the manual may be made to help ensure fidelity to the original model. The original model itself will not be changed so as to enable the feasibility trial participants to be included in the full dataset (i.e. the feasibility trial will act an internal pilot for the main trial).
Full Trial: Months 16-39
The intervention will continue to be implemented with any additional procedures developed in the feasibility trial to ensure closer fidelity to the model.
At the end of the internal pilot trial, recruitment methods, acceptability of the intervention, attendance rates at advice sessions and willingness of commissioners to continue the CAB service will be assessed.