Debt counselling for depression in primary care


UK Clinical Trials, clinical research

Primary Trial ID Number


Background and study aims Depression and associated anxiety are common among patients seen in general practices. Many such patients also have debt and prolonged absence from work. There is increasing evidence of a relationship between indebtedness, depression and risk of self-harm and suicide. It is suggested that anti-depressants and talking therapies are cost-effective in the treatment of depression in general practices. Whilst indebtedness and poverty are common in society, particularly in areas of deprivation and high unemployment, the economic recession has worsened these problems. Whilst debt advice services are widely available, there is no robust evidence of their impact on mental health outcomes or their cost-effectiveness. There is a long history of welfare advice provided in primary care, particularly in areas of greatest economic need. However, debt advice is different from general welfare advice, and in the model we propose testing (that provided by the Citizen’s Advice Bureau – CAB) different from many of the commercially available offers of debt consolidation. Instead it focuses on assessing the level and urgency of debts and arrears and triaging to specific detailed advice on debt, or money management. We propose to test the impact of a shared assessment and management plan between GPs and CAB staff, linked to sessions of individual debt advice. Who can participate? Patients with depression (with and without additional anxiety) who also are worried about debt. What does the study involve? People wishing to participate in the study will first be screened to see if they are eligible to take part. If they are, they will complete an initial assessment visit with a researcher in the participant’s own home or at a venue of their choosing. After this, the participant will be randomly allocated to either receive debt advice from the Citizens Advice Bureau (CAB) and a shared comprehensive assessment between a general practitioner (GP) and the CAB advisor, or to receive treatment as usual and a debt advice leaflet. Participants will take part in two further assessment visits with a researcher – one at 3 months after allocation and one at 12 months. A number of participants will also be invited to take part in two interviews with a second researcher to explore the participant’s experience of debt, its impact on their life and their experience of the intervention. A number of staff (GPs and CAB advisors) will also take part in interviews 6-12 months after the start of their participation. The purpose of these interviews is to look at the intervention in more detail from the professionals’ point of view. What are the possible benefits and risks of participating? We hope that the debt advice will aid recovery from depression. The likely main risk is that people may become distressed when talking about their current difficulties. Researchers will follow protocol guidance in such circumstances. Where is the study run from? The study will recruit from sites in England and Wales and will be managed from three centres: Liverpool University (lead University), Plymouth University and Swansea University. Participants will be recruited from general practices in Liverpool, Plymouth and Bridgend. When is the study starting and how long is it expected to run for? The study will run from June 2014 until May 2016. Who is funding the study? National Institute for Health Research (NIHR) (UK). Who is the main contact? Dr Adele Ring
Research Details
To what extent does debt advice from Citizens Advice Bureau counsellors for patients with debt and depression, accessed through general practices, make a difference to patients’ recovery from depression.
Not Applicable
Study Design
Randomised; Interventional; Design type: Treatment
Study Type
Patients are randomised to two groups: 1. GP treatment as usual (TAU) supplemented by a debt management advice leaflet (control) 2. GP treatment as usual supplemented by debt advice leaflet and primary care based CAB debt advice, including a shared GP/CAB Advisor comprehensive assessment (intervention) Follow Up Length: 12 month(s)

Intervention Type
Primary Outcome Measures
Depression (Measured by BDI-II score); Timepoint(s): Baseline, 4 and 12 months
Secondary Outcome Measures
1. Explanatory measures; Timepoint(s): Baseline and 4 months
2. Health and social care utilisation and employment factors; Timepoint(s): Baseline, 4 and 12 months
3. Health-related QOL; Timepoint(s): Baseline, 4 and 12 months
4. Life events; Timepoint(s): Baseline and 4 months
5. Psychological wellbeing; Timepoint(s): Baseline, 4 and 12 months
6. Service satisfaction; Timepoint(s): 4 months
7. Substance misuse; Timepoint(s): Baseline, 4 and 12 months

Age Range
Who Can Participate
Number of Participants
Planned Sample Size: 470; UK Sample Size: 470; Description: 390 if individual randomisation; 470 if cluster randomised
Participant Inclusion Criteria
1. Aged 18 or above
2. Scoring 14 or above on the BDI
3. Self-identifying as having worries about debt
Target Gender: Male & Female ; Lower Age Limit 18 years
Participant Exclusion Criteria
1. Housebound and/or unable to get to CAB advice sessions
2. Actively suicidal or psychotic and/or severely depressed and unresponsive to treatment
3. Unlikely to comply with the intervention or follow-up e.g. experiencing severe problems with addiction to alcohol or illicit drugs
4. Unable or unwilling to give written informed consent to participate in study
5. Currently participating in another research study including follow-up data collection phase
6. Has received CAB debt advice in the past 12 months

Trial Location(s)
L69 3GB
Trial Contact(s)
Primary Trial Contact
Dr Adele Ring

Scientific Title
Debt Counselling for Depression Randomised controlled trial
EudraCT Number
Sorry, this information is not available
National Institute for Health Research (NIHR) (UK)
Grant Codes: 11/148/01
Other Study ID Numbers
University of Liverpool (UK)


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