title: Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial.
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.
  
  
  BACKGROUND
  Current Controlled Trails: ISRCTN17831610.
authors: Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. wm.seekles@psy.vu.nl
authors: Wike
authors: W
authors: Seekles
authors: Annemieke
authors: A
authors: van Straten
authors: Aartjan
authors: A
authors: Beekman
authors: Harm
authors: H
authors: van Marwijk
authors: Pim
authors: P
authors: Cuijpers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance; D011320:Primary Health Care; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D012648:Self Care; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents