title: Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders.
abstract: BACKGROUND
  Mood and anxiety disorders are highly prevalent and have a large impact on the lives of the affected individuals. Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders. A stepped care program is characterized by different treatment steps that are arranged in order of increasing intensity.
  
  
  METHODS
  This study is a randomised controlled trial with two conditions: stepped care and care as usual, whereby the latter forms the control group. The stepped care program consists of four evidence based interventions: (1) Watchful waiting, (2) Guided self-help, (3) Problem Solving Treatment and (4) Medication and/or specialized mental health care. The study population consists of primary care attendees aged 18-65 years. Screeners are sent to all patients of the participating general practitioners. Individuals with a Diagnostic and Statistical Manual of mental disorders (DSM) diagnosis of major depression, dysthymia, panic disorder (with or without agoraphobia), generalized anxiety disorder, or social phobia are included as well as individuals with minor depression and anxiety disorders. Primary focus is the reduction of depressive and anxiety symptoms. Both conditions are monitored at 8, 16 and 24 weeks.
  
  
  CONCLUSIONS
  This study evaluates the effectiveness of a stepped care program for patients with depressive and anxiety disorder. If effective, a stepped care program can form a worthwhile alternative for care as usual. Strengths and limitations of this study are discussed.
  
  
  BACKGROUND
  Current Controlled Trails: ISRCTN17831610.
authors.affiliation: Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. wm.seekles@psy.vu.nl
authors.forename: Wike
authors.initials: W
authors.lastname: Seekles
authors.forename: Annemieke
authors.initials: A
authors.lastname: van Straten
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
authors.forename: Harm
authors.initials: H
authors.lastname: van Marwijk
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003266:Continuity of Patient Care; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D011569:Psychiatric Status Rating Scales; D012107:Research Design