Lifetime prevalence rates of Major Depressive Disorder (MDD) in Canada are between 10-12%
with approximately 1.5 million Canadians reporting depression in any given year. Alarmingly,
the burden of ill health associated with MDD is projected to increase worldwide such that by
the year 2020, depression will move from its current position of fourth to become the second
greatest burden of ill health, closely following ischaemic heart disease (Murray & Lopez,
1998). As depressed patients are often in frequent contact with their primary care physicians
for other health problems, effective depression treatment and management currently relies
heavily on the primary care sector. Cognitive behavioural therapy (CBT) is an empirically
supported psychotherapy that is recommended by the Canadian Network for Mood and Anxiety
Treatments Clinical Guidelines as a first-line treatment for depression. However, across
Canada, CBT is not readily accessible by primary care physicians for their patients,
particularly in rural areas.
To help address this nationwide need for CBT, British Columbia (BC) is the first and only
province in Canada to develop and implement a high capacity mental health service, Bounce
Back: Reclaim your Health (BB), for primary care patients with mild to moderate depression.
In BB, the patients' use of Cognitive-Behavioural Therapy (CBT) self-help materials is
supported via trained telephone coaches.
The primary objective of our proposed research is to provide direct evidence of the
effectiveness of the BB program, and, in particular, the telephone coaching component. The
investigators will test: (1) whether the BB program is more effective than general
practitioner (GP) treatment-as-usual (TAU); and (2) whether BB's positive results can be
attributed to the telephone coaching component, as this component is associated with the most
significant costs of the program. A secondary objective is to assess the cost-effectiveness
of such telephone support.