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- Page navigation anchor for Matching depression management to severity prognosis in primary care: remaining questionsMatching depression management to severity prognosis in primary care: remaining questions
It is with great interest that we read the paper by Fletcher and colleagues.1 It deals with a very interesting topic in primary care which is also close to our team’s research topics, and we commend the authors for trying to tackle the important problem of identifying the level of care intensity in stepped care for depression. We do have some concerns and questions, which we will detail below.
1. The authors use a clinical prediction tool that they (co)developed themselves.2 At the time, the need for validation of this tool was clearly stated in that paper. To our knowledge, this validation has still not been carried out, but the tool is nevertheless used in the trial. Even though the c-statistic was acceptable (0.74), 9% of patients with severe depression ended up in the ‘mild’ category using this tool.2 The risk of misclassification is therefore considerable. Could the authors comment on this?
2. Secondly, we have some questions about the high degree of attrition, which is not discussed further in the manuscript. About 45 000 patients were approached, of which only 1 868 ended up in the trial, which is 4% of the total. Could the authors elaborate on this? Furthermore, participant retention is also low, and higher in the control than in the intervention group (Figure 1). How might the flow of participants have influenced the intervention and research findings?
3. Participant recruitment and sc...
Show MoreCompeting Interests: None declared.