Search

Background: Family physicians have an important role to play in accessing and coordinating community mental health services and supports for patients affected by mood disorders such as depression and anxiety. Bounce Back is a program introduced in British Columbia in 2008 to help physicians meet the mental health needs of their patients while lessening the demand on the health care system. The program offers cognitive behavior therapy to patients with mild to moderate depression with or without anxiety who might benefit from a low-intensity intervention. Clinical measures such as the Patient Health Questionnaire are used to determine patient eligibility and for ongoing assessment of mental health status. Patients are ineligible if they require more intensive mental health services (e.g., they have bipolar disorder or cognitive impairment) and may become ineligible while in the program if their clinical presentation changes. Workbooks for the program include carefully sequenced questions designed to bring about change in how participants think and in what they do to improve how they feel. Coaches trained by registered psychologists provide motivational support by telephone and communicate with the referring health professional to provide updates on the status of the patient. In 2017 a study was undertaken to evaluate the clinical effectiveness of this program using data from the first 6 years of operation. Methods: Data were collected for 25 338 patients with closed cases who were referred to Bounce Back from 1 July 2008 to 31 March 2014. Clinical outcomes were explored in terms of improvement, remission, and recovery from depression and anxiety over time. Recovery was defined using criteria from the UK National Health Services program, Improving Access to Psychological Therapies, and presented as a percentage of patients who had scored in the subclinical range at completion after scoring in the clinical range at assessment. Means and standard deviations were calculated for patient age and clinical measure scores. Results: More women than men were referred to Bounce Back (74% vs 26%) and the mean age at referral was 44.5 years. Four groups of patients were identified: declined (patients who did not receive further assessment or coaching), inappropriate (patients deemed ineligible for the program), incomplete (patients who received some service but did not complete the program), and completed (patients with preintervention and postintervention scores for all clinical measures). When preintervention and postintervention scores were compared, patients were found to have significant reductions in symptoms of depression and anxiety. A recovery rate of 68.5% was calculated, based on 5537 participants who initially had symptoms of depression, anxiety, or both, and 3794 participants who no longer had clinical symptoms after completing the program. Conclusions: Study findings show Bounce Back is associated with positive outcomes for patients with mild to moderate depression with or without anxiety and that the program's clinical effectiveness is in line with initiatives assessed by other studies. While the study had some limitations regarding the grouping of patients, only patients completing the program had both preintervention and postintervention data, and the results would therefore not be affected by other possible grouping methods, suggesting the outcomes for the completed group would remain unchanged. Like other large-scale initiatives being implemented to provide low-intensity mental health treatments, Bounce Back allows for earlier and easier access to services and better matching of service intensity to need. [ABSTRACT FROM AUTHOR]