Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease

Trials

Linda Gask⁵  Sarah Knowles⁵  Chris Roberts⁵  Farheen Jeeva⁵  Linda Davies⁵  Mark Hann⁵  Waquas Waheed³  Chris Keyworth⁵  Isabel Adeyemi⁵  Kate Roughley⁵  Clare Baguley¹  Chris J Gibbons⁵  Charlotte Garrett⁵  Andrea Cherrington⁵  Carolyn Chew-Graham⁵  Peter Bower⁵  Chris Dickens²  Karina Lovell⁴  Peter A Coventry⁵ 

[1] IAPT North West Programme Field Lead, NHS North West, UK;Peninsula College of Medicine and Dentistry, University of Exeter and Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), Exeter, Devon, UK;Lancashire Care NHS Foundation Trust, Preston, UK;School of Nursing, Midwifery & Social Work and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK;Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

关键词: Collaborative care;    Primary care;    Coronary heart disease;    Diabetes;    Depression;   

Others  :  1095396
DOI  :  10.1186/1745-6215-13-139

 received in 2012-02-09, accepted in 2012-07-17,  发布年份 2012

【 摘 要 】

Background

Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices.

Methods

This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and/or general practitioner. The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist (SCL-90). Secondary outcomes include change in health status, self-care behaviors, and self-efficacy. A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented, and to explore sustainability beyond the clinical trial.

Discussion

COINCIDE will assess whether collaborative care can improve patient-centered outcomes, and evaluate access to and quality of care of co-morbid depression of varying intensity in people with diabetes/coronary heart disease. Additionally, by working with usual care providers such as IAPT, and by identifying and evaluating interventions that are effective and appropriate for routine use in the NHS, the COINCIDE trial offers opportunities to address translational gaps between research and implementation.

Trial Registration Number

ISRCTN80309252

Trial Status

Open

【 授权许可】

   
2012 Coventry et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Ustun T, Catterjj S: Depression: social and economic timebomb. In Global burden of depressive disorders and future projections. Edited by Tylee A. BMJ Books, London; 2001.
• [2]Mathers CD, Loncar D: Projections of global mortality and burden of disease from 2002 to 2030. Plos Medicine 2006, 3(11):e442.
• [3]Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007, 370(9590):851-858.
• [4]Iosifescu DV, Nierenberg AA, Alpert JE, Smith M, Bitran S, Dording C, Fava M: The impact of medical comorbidity on acute treatment in major depressive disorder. Am J Psychiatry 2003, 160(12):2122-2127.
• [5]DiMatteo MR, Lepper HS, Croghan TW: Depression is a risk factor for noncompliance with medical treatment - Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000, 160(14):2101-2107.
• [6]Ciechanowski PS, Katon WJ, Russo JE: Depression and diabetes - Impact of depression symptoms on adherence, function, costs. Arch Intern Med 2000, 160(21):3278-3285.
• [7]Chisholm D, Diehr P, Knapp M, Patrick D, Treglia M, Simon G, Grp L: Depression status, medical comorbidity and resource costs - Evidence from an international study of major depression in primary care (LIDO). Br J Psychiatry 2003, 183:121-131.
• [8]National Institute for Health and Clinical Excellence: Developing the clinical and health improvement indicators for the Quality and Outcomes Framework (QOF), Quick Reference Guide. 2009. http://www.nice.org.uk/media/750/E1/QOFQRGLRFinal.pdf webcite
• [9]National Collaborating Centre for Mental Health: Depression: the Treatment and Management of Depression in Adults (partial update of NICE clinical guideline 23); National Clinical Practice Guideline 90. 2009. http://www.nice.org.uk/nicemedia/pdf/Depression_Update_FULL_GUIDELINE.pdf webcite
• [10]National Collaborating Centre for Mental Health: NICE clinical guideline 91. 2009. [Depression in adults with a chronic physical health problem] http://www.nice.org.uk/nicemedia/live/12327/45909/45909.pdf webcite
• [11]Simon GE, Goldberg D, Tiemens BG, Ustun TB: Outcomes of recognized and unrecognized depression in an international primary care study. General Hospital Psychiatry 1999, 21(2):97-105.
• [12]Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A: Recognition of depression by non-psychiatric physicians - A systematic literature review and meta-analysis. Journal of General Internal Medicine 2008, 23(1):25-36.
• [13]National Collaborating Centre for Mental Health: Depression in Adults With Chronic Physical Health Problems. 2009. [Full guideline. National Clinical Practice Guideline 91] http://www.nccmh.org.uk/guidelines_dchp.html webcite
• [14]Kendrick T, Dowrick C, McBride A, Howe A, Clarke P, Maisey S, Moore M, Smith PW: Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. British Medical Journal 2009, 338:1-8.
• [15]Kessler D, Lloyd K, Lewis G, Gray DP: Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. British Medical Journal 1999, 318(7181):436-439.
• [16]Burroughs H, Lovell K, Morley M, Baldwin R, Burns A, Chew-Graham C: ‘Justifiable depression’: how primary care professionals and patients view late-life depression? a qualitative study. Fam Pract 2006, 23(3):369-377.
• [17]Rost K, Nutting P, Smith J, Coyne JC, Cooper-Patrick L, Rubenstein L: The role of competing demands in the treatment provided primary care patients with major depression. Archives of Family Medicine 2000, 9(2):150-154.
• [18]Coventry PA, Hays R, Dickens C, Bundy C, Garrett C, Cherrington A, Chew-Graham C: Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care. BMC Fam Pract 2011, 12:10.
• [19]Aragones E, Labad A, Pinol JL, Lucena C, Alonso Y: Somatized depression in primary care attenders. J Psychosom Res 2005, 58(2):145-151.
• [20]Bower P, Gilbody S: Managing common mental health disorders in primary care: conceptual models and evidence base. British Medical Journal 2005, 330(7495):839-842.
• [21]Gilbody S, Whitty P, Grimshaw J, Thomas R: Educational and organizational interventions to improve the management of depression in primary care - A systematic review. JAMA 2003, 289(23):3145-3151.
• [22]Wagner EH, Austin BT, VonKorff M: Organizing care for patients with chronic illness. Milbank Quarterly 1996, 74(4):511.
• [23]Katon W, Robinson P, VonKorff M, Lin E, Bush T, Ludman E, Simon G, Walker E: A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry 1996, 53(10):924-932.
• [24]Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ: Collaborative care for depression - A cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006, 166(21):2314-2321.
• [25]Katon WJ, Von Korff M, Lin EHB, Simon G, Ludman E, Russo J, Ciechanowski P, Walker W, Bush T: The pathways study - A randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry 2004, 61(10):1042-1049.
• [26]Katon WJ, Lin EHB, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, Rutter CM, McGregor M, McCulloch D: Collaborative Care for Patients with Depression and Chronic Illnesses. N Engl J Med 2010, 363(27):2611-2620.
• [27]Simon G: Collaborative care for depression - Is effective in older people, as the IMPACT trial shows. British Medical Journal 2006, 332(7536):249-250.
• [28]Katon W, Unutzer J: Collaborative care models for depression - Time to move from evidence to practice. Arch Intern Med 2006, 166(21):2304-2306.
• [29]Richards DA, Hughes-Morley A, Hayes RA, Araya R, Barkham M, Bland JM, Bower P, Cape J, Chew-Graham CA, Gask L, et al.: Collaborative Depression Trial (CADET): multi-centre randomised controlled trial of collaborative care for depression - study protocol. BMC Heal Serv Res 2009, 9:188.
• [30]Tylee A, Ashworth M, Barley E, Brown J, Chambers J, Farmer A, Fortune Z, Haddad M, Lawton R, Mann A, et al.: Up-Beat UK: A programme of research into the relationship between coronary heart disease and depression in primary care patients. BMC Fam Pract 2011, 123:38.
• [31]Morgan M, Dunbar J, Reddy P, Coates M, Leahy R: The TrueBlue study: Is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes? BMC Fam Pract 2009, 10:46.
• [32]Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unutzer J, Miranda J, Carney MF, Rubenstein LV: Impact of disseminating quality improvement programs for depression in managed primary care - A randomized controlled trial. JAMA 2000, 283(2):212-220.
• [33]Cooksey D: A review of UK health research funding. HMSO, London; 2006. http://www.official-documents.gov.uk/document/other/0118404881/0118404881.pdf webcite
• [34]Richards DA, Lovell K, Gilbody S, Gask L, Torgerson D, Barkham M, Bland M, Bower P, Lankshear AJ, Simpson A, et al.: Collaborative care for depression in UK primary care: a randomized controlled trial. Psychol Med 2008, 38(2):279-287.
• [35]Katon W, Vonkorff M, Lin E, Walker E, Simon GE, Bush T, Robinson P, Russo J: Collaborative management to acheive treatment guidelines - impact on depression in primary care. JAMA 1995, 273(13):1026-1031.
• [36]Gunn J, Diggens J, Hegarty K, Blashki G: A systematic review of complex system interventions designed to increase recovery from depression in primary care. BMC Heal Serv Res 2006, 6:88.
• [37]May C, Fleming C: The professional imagination: Narrative and the symbolic boundaries between medicine and nursing. J Adv Nurs 1997, 25(5):1094-1100.
• [38]McDonald R, Campbell S, Lester H: Practice nurses and the effects of the new general practitioner contract in the English National Health Service: The extension of a professional project? Social Science and Medicine 2009, 68(7):1206-1212.
• [39]Macdonald W, Rogers A, Blakeman T, Bower P: Practice nurses and the facilitation of self-management in primary care. J Adv Nurs 2008, 62(2):191-199.
• [40]Jansink R, Braspenning J, van der Weijden T, Elwyn G, Grol R: Primary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis. BMC Fam Pract 2010, 11:41.
• [41]Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, Pickering RM, Baker NG, Henson A, Preece J, et al.: Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet 2000, 355(9199):185-191.
• [42]Centre for Economic Performance’s Mental Health Policy Group: The Depression Report. A New Deal for Depression and Anxiety Disorders. London School of Economics, London; 2006.
• [43]Department of Health: No Health Without Mental Health: A cross-government strarategy for people of all ages. DoH, London; 2011.
• [44]Department of Health: Talking Therapies: A four-year plan of action. DoH, London; 2011. [A supporting document to no health without mental health: A cross-government mental health outcomes strategy for people of all ages]
• [45]Department for Communities and Local Government: The English Indicies of Deprivation. DCLG, London; 2010.
• [46]Office of National Statistics Census: General Report for England and Wales. Palgrave Macmillan, Basingstoke; 2001.
• [47]BMA and NHS Employers Association: Quality and Outcomes Framework guidance for GMS contract 2011/2012 Delivering Investment in General Practice. BMA, London; 2011.
• [48]Kroenke K, Spitzer RL, Williams JBW: The PHQ-9 - Validity of a brief depression severity measure. Journal of General Internal Medicine 2001, 16(9):606-613.
• [49]Patterson S, Mairs H, Borschmann R: Successful recruitment to trials: a phased approach to opening gates and building bridges. BMC Medical Research Methodology 2011., 11
• [50]Page MJ, French SD, McKenzie JE, O’Connor DA, Green SE: Recruitment difficulties in a primary care cluster randomised trial: investigating factors contributing to general practitioners’ recruitment of patients. BMC Medical Research Methodology 2011, 11:35.
• [51]Farrin A, Russell I, Torgerson D, Underwood M, Team UBT: Differential recruitment in a cluster randomized trial in primary care: the experience of the UK back pain, exercise, active management and manipulation (UK BEAM) feasibility study. Clinical Trials 2005, 2(2):119-124.
• [52]Simpson S, Corney R, Fitzgerald P, Beecham J: A randomised controlled trial to evaluate the effectiveness and cost-effectiveness of counselling patients with chronic depression. Health Technology Assessment. Winchester, England 2000, 4(36):1-83.
• [53]Watson JM, Torgerson DJ: Increasing recruitment to randomised trials: a review of randomised controlled trials. BMC Medical Research Methodology 2006, 6:34.
• [54]Gilbody S, Richards D, Barkham M: Diagnosing depression in primary care using self-completed instruments: UK validation of PHQ-9 and CORE-OM. Br J Gen Pract 2007, 57(541):650-652.
• [55]van Bastelaar KMP, Pouwer F, Geelhoed-Duijvestijn PHLM, Tack CJ, Bazelmans E, Beekman AT, Heine RJ, Snoek FJ: Diabetes-specific emotional distress mediates the association between depressive symptoms and glycaemic control in Type 1 and Type 2 diabetes. Diabet Med 2010, 27(7):798-803.
• [56]Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, Blanco E, Haro JM: Assessing depression in primary care with the PHQ-9: Can it be carried out over the telephone? Journal of General Internal Medicine 2005, 20(8):738-742.
• [57]Gilbody S, Richards D, Brealey S, Hewitt C: Screening for depression in medical settings with the patient health questionnaire (PHQ): A diagnostic meta-analysis. Journal of General Internal Medicine 2007, 22(11):1596-1602.
• [58]Brennan C, Worrall-Davies A, McMillan D, Gilbody S, House A: The Hospital Anxiety and Depression Scale: A diagnostic meta-analysis of case-finding ability. J Psychosom Res 2010, 69(4):371-378.
• [59]Gilbody S, Sheldon T, House A: Screening and case-finding instruments for depression: a meta-analysis. Canadian Medical Association Journal 2008, 178(8):997-1003.
• [60]Ekers D, Richards D, Gilbody S: A meta-analysis of randomized trials of behavioural treatment of depression. Psychol Med 2008, 38(5):611-623.
• [61]Ekers D, Richards D, McMillan D, Bland JM, Gilbody S: Behavioural activation delivered by the non-specialist: phase II randomised controlled trial. Br J Psychiatry 2011, 198(1):66-72.
• [62]Richards D, Chellingsworth M, Hope R, Turpin G, Whyte M: Reach out, National Programme Supervisor Materials to Support the Delivery of Training for Psychological Wellbeing Practitioners Delivering Low Intensity Interventions. Rethink, London; 2010.
• [63]Turpin G, Wheeler S: IAPT Supervision Guidelines. IAPT, London; 2011.
• [64]Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L: The Hopkins Symptom Checklist (HSCL). A measure of primary symptom dimensions. Modern Problems of Pharmacopsychiatry 1974, 7:79-110.
• [65]Gwirtsman HE, Blehar MC, McCullough JP, Kocsis JH, Prien RF: Standardized assessment of dysthymia: Report of a National Institute of Mental Health conference. Psychopharmacol Bull 1997, 33(1):3-11.
• [66]The EuroQoL Group: EuroQol--a new facility for the measurement of health-related quality of life. Health policy (Amsterdam, Netherlands) 1990, 16(3):199-208.
• [67]Janssen MF, Lubetkin EI, Sekhobo JP, Pickard AS: The use of the EQ-5D preference-based health status measure in adults with Type 2 diabetes mellitus. Diabet Med 2011, 28(4):395-413.
• [68]Skevington SM, Lotfy M, O’Connell KA: The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial - A report from the WHOQOL group. Quality of Life Research 2004, 13(2):299-310.
• [69]Asnani MR, Lipps GE, Reid ME: Utility of WHOQOL-BREF in measuring quality of life in sickle cell disease. Health Qual Life Outcomes 2009, 7:75.
• [70]The Diabetes Control and Complications Trial Research Group: Influence of intensive diabetes treatment on quality-of-life outcomes in the diabetes control and complications trial. Diabetes Care 1996, 19(3):195-203.
• [71]Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, Fihn SD: Development and evaluation of the seattle angina questionnaire - a new functional status measure for coronary-artery disease. J Am Coll Cardiol 1995, 25(2):333-341.
• [72]Spitzer RL, Kroenke K, Williams JBW, Lowe B: A brief measure for assessing generalized anxiety disorder - The GAD-7. Arch Intern Med 2006, 166(10):1092-1097.
• [73]Lorig K, Steward A: P R: Outcome measures for health education and other health care interventions. Sage, Thousand Oaks; 1996.
• [74]Osborne RH, Elsworth GR, Whitfield K: The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Education and Counseling 2007, 66(2):192-201.
• [75]Attkisson CC, Zwick R: The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning 1982, 5(3):233-237.
• [76]Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SA: Development and validation of the patient assessment of chronic illness care (PACIC). Medical Care 2005, 43(5):436-444.
• [77]Glasgow RE, Whitesides H, Nelson CC, King DK: Use of the Patient Assessment of Chronic Illness Care (PACIC) with diabetic patients - Relationship to patient characteristics, receipt of care, and self-management. Diabetes Care 2005, 28(11):2655-2661.
• [78]Schmittdiel J, Mosen DM, Glasgow RE, Hibbard J, Remmers C, Bellows J: Patient assessment of chronic illness care (PACIC) and improved patient-centered outcomes for chronic conditions. Journal of General Internal Medicine 2008, 23(1):77-80.
• [79]Goldstein MG, Whitlock EP, DePue J: Multiple behavioral risk factor interventions in primary care summary of research evidence. American Journal of Preventive Medicine 2004, 27(2):61-79.
• [80]Whitlock EP, Orleans CT, Pender N, Allan J: Evaluating primary care behavioral counseling interventions - An evidence-based approach. American Journal of Preventive Medicine 2002, 22(4):267-284.
• [81]Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G, Pitula CR, Froelicher ES, Czajkowski S, Youngblood M, Huber M, et al.: A short social support measure for patients recovering from myocardial infarction: the ENRICHD Social Support Inventory. Journal of Cardiopulmonary Rehabilitation 2003, 23(6):398-403.
• [82]Sheehan DV, HarnettSheehan K, Raj BA: The measurement of disability. Int Clin Psychopharmacol 1996, 11:89-95.
• [83]Metaphysics of measurement: The case of adult attachment. Edited by Griffin D, Bartholomew K. Jessica Kingsley, London; 1994.
• [84]Rahman A, Iqbal Z, Waheed W, Hussain N: Translation and cultural adaptation of health questionnaires. The Journal of the Pakistan Medical Association 2003, 53(4):142-147.
• [85]Mead N, Bower P, Roland M: The General Practice Assessment Questionnaire (GPAQ) - Development and psychometric characteristics. BMC Fam Pract 2008, 9:13.
• [86]Bayliss EA, Ellis JL, Steiner JF: Seniors’ self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. Journal of Clinical Epidemiology 2009, 62(5):550-557.
• [87]Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D: The revised Illness Perception Questionnaire (IPQ-R). Psychol Heal 2002, 17(1):1-16.
• [88]Levav I, Kohn R, Montoya I, Palacio C, Rozic P, Solano I, Valentini W, Vicente B, Morales JC, Eigueta FE, et al.: Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial. Psychol Med 2005, 35(1):35-45.
• [89]Gask L, Bower P, Lovell K, Escott D, Archer J, Gilbody S, Lankshear AJ, Simpson AE, Richards DA: What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model. Implement Sci 2010., 5
• [90]Laws RA, Kirby SE, Davies GPP, Williams AM, Jayasinghe UW, Amoroso CL, Harris MF: “Should I and Can I”: A mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care. BMC Health Serv Res 2008., 8
• [91]Gunn JM, Palmer VJ, Dowrick CF, Herrman HE, Griffiths FE, Kokanovic R, Blashki GA, Hegarty KL, Johnson CL, Potiriadis M: Embedding effective depression care: using theory for primary care organisational and systems change. Implement Sci 2010., 5
• [92]May C, Finch T: Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory. Sociology 2009, 43(3):535-554.
• [93]Fenwick E, Claxton K, Sculpher M: Representing uncertainty: The role of cost-effectiveness acceptability curves. Heal Econ 2001, 10(8):779-787.
• [94]Sendi PP, Briggs AH: Affordability and cost-effectiveness: Decision-making on the cost-effectiveness plane. Health Econ 2001, 10(7):675-680.
• [95]World Medical Association General Assembly: World Medical Association Declaration of Helsinki. Ferney-Voltaire, France, WMA; 2008. [Ethical Principles for Medical Research Involving Human Subjects - Seoul Amendment]
• [96]Medical Research Council: Guidelines for Good Clincial Practice in Clinical Trials. MRC, London; 1998.
• [97]INVOLVE: A guide to reimbursing and paying members of the public who are actively invovled in research. National Institute for Health Research, London; 2006.
• [98]Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA: Integrating co-morbid depression and chronic physical disease management: Identifying and resolving failures in self-regulation. Clin Psychol Rev 2008, 28(8):1426-1446.