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Additional file 1: Table 1. Participant timeline.

Background: Randomised controlled trials, and in particular those of psychosocial interventions, often fail to recruit to target, resulting in underpowered trials with poor generalisability of findings. The objectives of this study was to explore the views of healthcare professionals on recruiting to psychosocial research studies, and to explore their views on factors that may hinder or facilitate recruitment. Methods: We conducted 14 semi-structured interviews, with healthcare professionals who had been involved in recruitment into a randomised controlled trial of a talking therapy for depression in patients with advanced cancer. Interviews were transcribed and analysed using thematic analysis. Results: Six primary themes were identified, comprised of 15 subthemes. Attitudes towards research were largely positive. Health care professionals identified lack of time and narrow screening criteria as barriers to recruitment, and also noted the tendency to withhold participants from research for reasons other than eligibility (e.g., gatekeeping). The engagement of the study team with the clinical recruitment site, and the frequent presence of a researcher in clinics, were noted as facilitating recruitment. Conclusions: Healthcare professionals involved in recruiting to trials of psychosocial interventions hold generally positive views of psychosocial research, but report that constraints limit their ability to recruit. The findings from this study can inform how best to design trials, and in particular trials of psychosocial interventions, and train health care professionals for the study, to maximise recruitment. Trial registration: Controlled Trials ISRCTN07622709, registered 15 July 2011

Background: Whilst evidence suggests cognitive behaviour therapy (CBT) may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT), a talking control (TC) and treatment as usual (TAU), delivered in a primary care setting, for older people with depression.Methods: Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II) was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up.Results: Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs) were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference 427 pound, 95% CI: 56 pound - 787 pound, p < 0.001). Reductions in BDI-II scores were significantly greater in the CBT group (difference 3.6 points, 95% CI: 0.7-6.5 points, p = 0.018). CBT is associated with an incremental cost of 120 pound per additional point reduction in BDI score and a 90% probability of being considered cost-effective if purchasers are willing to pay up to 270 pound per point reduction in the BDI-II score.Conclusions: CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than 115 pound.

People with intellectual disability are at a greater risk of developing common mental disorders. In the United Kingdom, the National Institute for Health and Clinical Excellence guidelines recommend cognitive behavioural therapy (CBT) as the treatment of choice for such problems. Even though there is growing evidence that people with mild intellectual disability can benefit from CBT, there are no manuals to assist in the delivery of the treatment. Previously published material from journals and books describing both CBT in people with intellectual disability and the general population was reviewed to create the first draft. Further consultations with professionals and service users with intellectual disability on the content, accessibility and language that was used in the manual were carried out. Specific materials were developed for use in the therapy sessions and for homework. The manual, written for trained therapists, provides generic information about communication and thinking styles in people with mild intellectual disability and describes in detail how to conduct each session. It contains also contains the materials and a leaflet to help carers support the treatment. Manualised treatments are helpful in maintaining a consistent approach to treatment and may be more beneficial for hard to reach population groups.

Background Chronotherapy (sleep deprivation, sleep phase shifting and/or the use of bright light) combines non-invasive and non-pharmacological interventions that may act rapidly against depressive symptoms. However, to date no meta-analysis has been conducted to examine their effectiveness. Methods We carried out meta-analysis of 16 studies (four randomised controlled trials and 12 open-label case series) with between-subject comparisons between experimental and control conditions for RCTs and within-subject comparisons between baseline and follow-up for all studies. Results Overall chronotherapy was generally superior to other therapies such as psychotherapy, antidepressants, exercise or light therapy alone after 5–7 days. For RCTs, chronotherapy was favoured (Hedge's g = 0.62, 95% CI 0.23–1.01) compared to control treatments such as antidepressants and exercise. 33.0% of patients were responders after 5–7 days in the chronotherapy group and 1.5% of patients in the control condition (OR = 7.58, 95% CI 2.03–28.28). For the case series, large effect sizes were found by 5–7 days (g = 1.78, 95% CI 1.49–2.07). In the case series, 61.6% of patients were classed as responders. Limitations The number of RCTs included in this meta-analysis was small, and the potential for risk of bias could not be ascertained accurately. One specific limitation is that studies nearly all included in-patients and the results may not be generalisable to out-patients, and nearly all the subjects lacked credibility ratings before receiving treatment. Conclusions Chronotherapy appears to be effective and well-tolerated in depressed patients. Nevertheless, further clinical and cost effectiveness studies are needed.