Table 2 Description of interventions and results of studies with clinician training (education) intervention

Adebowale et al. (2014) [30]

Training course (locally developed from the WHO mhGAP intervention guide)

Three days, 2 months (8 weeks)

Case vignettes to assess ability to make accurate diagnosis and to list appropriate treatment recommendations

A total of 92.5% pre-training and 93.8% post training, P = 0.200

Alexander et al. (2013) [31]

Training which focused on providing basic information about depression and demonstration of a depression-screening strategy

One hour, 2 months

Self-reported questionnaire and case vignettes

A total of 22.2% in the intervention and 16.7% in the control group (P > 0.05)

Andersen et al. (1990) [32]

A single evening seminar focused on the diagnosis, treatment, and referral of selected DSM-III/DSM-IIIR affective and anxiety disorders in primary care medicine)

Three and half hour, 1–8 weeks

Diagnostic knowledge inventory, which includes 18 paragraph-length case vignettes

Mean diagnostic accuracy 1.35 in the intervention group vs 0.97 in the control (P < 0.01). Proportion of physicians diagnosing cases correctly in the intervention and control groups at pretest 44.5 vs 53.4 and posttest (54.2 vs 40.9), P < 0.12

Bodlund et al. (1999) [33]

Regular consultations on a fortnightly basis (GPs had the opportunity to present cases with manifest or possible psychiatric disorders to the psychiatrist during 90-min sessions). This procedure was complemented with 2–3 training sessions

One year, 1 year

Hospital Anxiety and Depression scale and medical records

Prevalence increased from 3.7 to 4.7% (P > 0.05). Cases with clinically diagnosed depression increased from 4.0 to 7.9% (P < 0.05). Agreement between HAD diagnosis and clinical evaluation of depressive disorders improved from 20% (k = 0.18) to 45% (k = 0.54). After 1 year, GPs identified twice as many of the patients that suffered from anxiety or depression

Davidson et al. (2006) [34]

GPs attended a single education session delivered by a psycho-geriatrician. The session covered the diagnosis and treatment of late-life depression and training in the use of the Cornell Scale. Nursing staff attended a session, delivered by a clinical psychologist with expertise in late-life depression

Single education session

Patient file review form, Cornell Scale for Depression in Dementia and Algorithm for the assessment of depression in the elderly

At review, 24% of patients had Cornell Scale scores > 10. A further 32% had Cornell scores between 6 and 9

Fallucco et al. (2019) [35]

A seminar plus a practical clinical skill in assessment and treatment of adolescent depression. Training was led by a psychiatrist and was followed by a 30-min debriefing and question-and-answer period. PCPs received an educational packet including copies of the screening tool, treatment algorithms, and antidepressant medication dosing guidelines

Sixty-minute seminar and 60-min practical clinical skill, 12 months

The EMR was queried for specific procedural codes for depression screening and for any adolescent well-visit with a new diagnosis of major depressive disorder

In the year before the training intervention, 28 of 3150 (0.89%) adolescents were diagnosed with depression compared with 88 of 3958 (2.22%) adolescents seen after training. The odds of receiving a new diagnosis of depression were almost three times higher after training (OR = 2.7; 95% CI = 1.8–4.2, p < .0001)

Garg et al. (2019) [36]

On-site training section of a proposed 1-year-long NIMHANS Extension for Community Healthcare Outcomes training consisted of 2 h of didactic session on a topic, followed by a 2-h visit to the outpatient department

Two weeks, the PCDs were administered the vignettes before the commencement and after the completion of the onsite training program (2 weeks)

Ten case vignettes: each vignette was worth 10 marks, five each for diagnosis and management (a total score of 100)

The post-training score (83.42 ± 10.38) was significantly higher than the baseline score (42.4 ± 23.10), P < 0.001. The improvement was significant across all the vignettes

Gomez-Restrepo (2007) [37]

Training was carried out that consisted of a theoretical part and a practical part, focusing on case discussion, role-playing games, and use of vignettes for clinical cases

A day training, 2 months

SSI-CIDI

Before training: n = 97/1647 = 5.9% (95% CI = 4.8–7.1) and after training: n = 196/1832 = 10.64% (CI = 9.2–12.06%)

Hannaford (1996) [38]

Educational intervention, details not reported

Three months, 5 months

Hospital Anxiety and Depression (HAD) scale

Before intervention missed diagnosis = 24.1% (124/515) and after intervention missed diagnosis =17.1% (81/475); absolute decrease 7% (95% CI = −2.0 to −12.0%), P < 0.005

Haddad et al. (2018) [39]

Training was delivered to groups of school nurses according to their service teams, which at the time of the study (2008–2011) were primary care trusts. The training sessions were delivered with an identical program and resources by the same trainers (clinicians and service user), with group sizes of around 10 staff attending

A day training with 4–6 weeks follow-up, 9 months

Vignette method

Sensitivity of depression recognition varied between the trial clusters from 52 to 86.7%; specificity varied between clusters from 39.3 to 57.1%. Specificity differed between groups following the intervention at 3 months (49.3% vs 57.1%, P = 0.039) and at 9 months (45.3% vs 52.9%, P = 0.001)

Kauye et al. (2014) [40]

PHC workers in the intervention group underwent a training program in mental health using a toolkit originally designed for Kenya

Five days training

The SCID for depression

Before intervention, 0% in intervention and control, and after intervention, 9% in the intervention and 1% in the control

Kick et al. (1999) [41]

The intervention group received instruction in and copies of the AHCPR Quick Reference Guide for depression in primary care. The residents were given copies of the PRIME-MD and taken through a training session utilizing its mood disorder module

Three times, once in a month, 6 months

Center for Epidemiologic Studies Depression Scale

At baseline, the intervention residents knew more DSM-IV criteria for depression (P = 0.03) than the control group. At 6 months, the intervention residents still knew more DSM-IV criteria for depression (P = .03)

Lin et al. (2001) [42]

Participants in the intervention group were given standard training. It had role plays, and those unable to attend small group sessions study, psychiatrists individually met them

Two hours training, 3 months

ICD classification, no scale mentioned

Before intervention, 1.84 per 100 visits in the intervention and 1.63 in the control; after Intervention, 1.91 in the intervention and 1.68 in the control

Kutcher et al. (2017) [43]

Teachers were trained in the use of a mental health literacy curriculum resource (“The African Guide”) and applied it in their classrooms. Teachers received training in how to identify youth who may be showing signs and symptoms of depression and how to refer them to their local community health clinics. Community health clinic staff received training in the youth depression identification, diagnosis, and treatment

Six months

Kutcher Adolescent Depression Scale and chart review

One-hundred twenty-one youth screened of which 107 (88.4%) screened as potentially positive for depression. Then, in health facilities, 85 youth (71.4%) were diagnosed with depression using the tool

Pond et al. (1994) [44]

A brief structured educational visit to the doctor by an academic detailer, a fellow GP. The academic detailer presents clear, concise, and relevant facts about depression on a one-to-one basis. The detailer attempted to be as interactive as the situation permitted

Six months

GPs diagnosis was compared with diagnosis using screening instruments (GDS, CEI)

GP identification vs GDS-10: kappa increased from 0.06 to 0.16 (P = 0.21), and sensitivity improved from 33 to 42%, while specificity remained the same. GP identification vs GDS-13: kappa increased from 0.11 to 0.37 (P = 0.03), and sensitivity improved from 36 to 56%, while specificity remained about the same. GP identification vs DSM III-R and ICD-10 diagnoses: kappa increased significantly (P = 0.03 and P = 0.02, respectively)

Thompson et al. (2000) [24]

Practical guideline to the detection, assessment, and management of depression was provided. Education was provided in two parts. Seminars, in groups of up to 20, were held at the beginning of the intervention year. Each practice received seminars. Teaching was supplemented by videotapes to demonstrate interview and counseling skills, small-group discussion of cases, and role play if appropriate

Four hours seminar plus follow-up education for 9 months depending on the need, 6 weeks and 6 months

Diagnosis by physician was done using a 4-point global scale and HADS

The sensitivity of physicians to depressive symptoms was 37% in the intervention group and 35% in the control group after seminars. A total of 39% in the intervention group and 36% in the control group after education and 34% in the intervention group and 36% in the control group at the end of the study

Van Daele et al. (2015) [45]

Minimal intervention consisting of information, skill training, and discussion. The training was given by a researcher and a staff member of the home nursing organization for small groups of about ten home nurses at a time. It started with a discussion on familiar topics

One-hour session, 3 and 7 months

Using the screening questions formulated by Whooley et al. (1997) and Arroll et al. (2005) and the reporting sheets

In the 3 months following the intervention, home nurses detected 42 depressed patients and family caregivers (N = 16 out of 63) in the intervention group) and (N = 2 out of 29) in the control group, P = 0 038

Vanos et al. (1999) [46]

The training consisted of eight sessions. The A group training included sessions about somatization, sleeping problems, and chronic complaining, plus an introductory and a booster session. In the B group, the introductory and booster sessions were replaced by two sessions on anxiety disorders. Each session followed a similar structure: (1) discussion of the normal practices and difficulties of the trainees; (2) a short lecture by the psychiatrist trainer; (3) illustration with video-taped consultations; (4) introduction of guidelines and protocols for screening, diagnosis, or interventions; (5) practice using various forms of hands-on learning (e.g., role playing); and (6) evaluation

8 sessions 2.5 h each, 1 year

The 12-item version of the GHQ to screen for psychological distress; CIDI-PHC was used for the second-stage baseline assessment of patients and yields ICD-10 diagnosis

Diagnosis of depression (pre 40%, post 48%, P = 0.12). There was significant improvement in the A group (pre 35%, post 51%, P = 0.03), but none in the B group (pre 45%, post 45%, P = 0.99). In adjusted model, there was no overall significant pre-post differences in diagnosis of depression (OR: 1.39, P = 0.15)

Worrall et al. (1999) [47]

Physicians in the intervention group attended a small educational workshop where they were introduced to the clinical practice guidelines formulated by the Canadian Medical Association for the detection and treatment of depression. Workshops were led by a psychiatrist and an academic family physician

Three-hour educational session and consultation by psychiatrist at a specific time each week, 6 months

Data were collected from physicians record; each patient was rated on a 4-point ordinal scale (4 = severe depression to 1 = absence of depressive symptoms). CES-D was used for assessing patient outcome

Physicians in the intervention group diagnosed 91 new cases of depression (mean 4.1 per physician) and those in the control group diagnosed 56 (mean 2.8 per physician). Fifty-three (93.4%) in the intervention group and 84 (94.6%) in the control group made correct diagnosis

Shirazi et al. (2013) [48]

Educational intervention tailored according to the participants’ readiness to change. Interactive workshop for a small group of GPs at a higher stage of readiness-to-change (“intention”) and interactive large group meeting for those with lower propensity to change (“attitude”). Interactive and multifaceted learning activities were used, such as case illustrations, standardized patients, role playing, buzz groups, programmed lectures, and snowball techniques. Printed materials were given to the participants

Two-day training (12 h education plus 8 h teacher contacts) for both groups and 4 h collaborative small group learning for the intervention group, 2 months after the intervention

Checklist compiled using Diagnostic and Statistical Manual of Mental Disorders IV criteria for diagnosis

Mean (SD) of performance regarding diagnosis at intervention group A vs. control group

• Pre-intervention 48 (22) vs. 48 (25) and post-intervention 63 (20) vs. 49 (24), P = 0.007

Mean (SD) of performance regarding diagnosis at intervention group B vs. control group

• Pre 33 (28) vs. 26 (31) and post 49 (35) vs. 22 (25), P < 0.001

Vicente et al. (2007) [49]

A brief educational training program for depression designed by the World Psychiatric Association. The World Psychiatric Association training module was administered in a seminar organized by the site coordinator, an experienced psychiatrist. The addition of case histories allowed for an interactive seminar. The attendees also received a printed copy of the materials reviewed

Two-day training for a total of 10 h, 1 month

Physician diagnosis from medical record and patient self-reported diagnosis using Zung Depression Scale and a symptom checklist that enabled making an approximate DSM-IV and ICD-10 diagnoses for a major depressive episode

The physicians diagnosed depression in 14.2% (n = 176) in phase 1 and 15.2% (n = 204) in phase 2 of the patients (change = 1%, P = 0.474). Agreement between the physician and patient self-reported diagnosis remained poor and showed no improvement following the educational program

Miller et al. (2020) [50]

A large perinatal collaborative care program was implemented. Educational programming pertaining to (1) the collaborative care model and (2) depression screening and treating was disseminated to obstetric providers and patients

Before intervention 129/1334 = 9.7% positive for depression and after intervention 310/3447 = 9.0%. Before intervention (postpartum care) 112/3097 = 3.6% positive for depression and after intervention 162/4167 = 3.9%