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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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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