Stepped care is no better than usual care in treating depression and anxiety in primary care

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There are increasing levels of interest in stepped care models to treat mental health problems in primary care.

This randomised controlled trial investigated the effectiveness of a stepped care programme for treating depression and anxiety in 120 adults (aged 18-65 years with minor or major DSM-IV depressive and/or anxiety disorders) in general practice.  Patients were randomised to stepped care or care as usual.

The stepped care program had four stages:

  1. Watchful waiting
  2. Guided self-help
  3. Short face-to-face problem solving treatment
  4. Medication and/or specialised mental health care

Patients were assessed at baseline and after 8, 16 and 24 weeks.

The results found that:

  • Depression and anxiety symptoms decreased significantly in both groups
  • Statistically, there was no significant difference between the groups (IDS: P = 0.35 and HADS: P = 0.64)
  • Half of the patients (48%) in both groups recovered from their DSM-IV diagnosis after 6 months

The authors concluded:

In summary we could not demonstrate that stepped care for depression and anxiety in general practice was more effective than care as usual.

Seekles W, van Straten A, Beekman A, van Marwijk H, Cuijpers P. Stepped care treatment for depression and anxiety in primary care: A randomized controlled trial. Trials. 2011 Jul 7;12(1):171. [Epub ahead of print] [Provisional PDF]

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