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Trials. 2011 Jul 7;12:171. doi: 10.1186/1745-6215-12-171.

Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial.

Author information

1
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. wm.seekles@psy.vu.nl

Abstract

BACKGROUND:

Depressive and anxiety disorders are common in general practice but not always treated adequately. Introducing stepped care might improve this. In this randomized trial we examined the effectiveness of such a stepped care model.

METHODS:

The study population consisted of primary care attendees aged 18-65 years with minor or major DSM-IV depressive and/or anxiety disorders, recruited through screening. We randomized 120 patients to either stepped care or care as usual. The stepped care program consisted of (1) watchful waiting, (2) guided self-help, (3) short face-to-face problem solving treatment and (4) pharmacotherapy and/or specialized mental health care. Patients were assessed at baseline and after 8, 16 and 24 weeks.

RESULTS:

Symptoms of depression and anxiety decreased significantly over time for both groups. However, there was no statistically significant difference between the two groups (IDS: P = 0.35 and HADS: P = 0.64). The largest, but not significant, effect (d = -0.21) was found for anxiety on T3. In both groups approximately 48% of the patients were recovered from their DSM-IV diagnosis at the final 6 months assessment.

CONCLUSIONS:

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

TRIAL REGISTRATION:

Current Controlled Trails: ISRCTN17831610.

PMID:
21736720
PMCID:
PMC3152524
DOI:
10.1186/1745-6215-12-171
[Indexed for MEDLINE]
Free PMC Article

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