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In a systematic review to determine the factors affecting recruitment into depression trials, researchers at the University of Manchester have found that the decision involves a judgement between risk and reward.

Depression is common and is predicted to become the single leading cause of disease burden worldwide by 2030. Researchers found that a significant number of patients do not fully recover despite treatment. Clinical trials are crucial for evaluating treatments but there are difficulties in recruiting participants into depression trials and as yet no study has examined the factors affecting recruitment.

The research team aimed to identify the factors affecting recruitment into depression trials and to develop a conceptual framework through systematic assessment of published qualitative research. Findings published in the Journal of Affective Disorders indicate that the decision to enter a depression trial is made by patients and gatekeepers based on the patient's health state at the time of being approached to participate; on their attitude towards the research and trial interventions; and on the extent to which patients become engaged with the trial.

The findings from this review have implications for the design and interventions to improve recruitment into depression trials. Such interventions may aim to diminish the perceived risks and increase the perceived rewards of participation.The effectiveness of these interventions on recruitment and retention can then be tested using methods developed by the MRC START project (http://www.population-health.manchester.ac.uk/mrcstart/)