title: Collaborative stepped care v. care as usual for common mental disorders: 8-month, cluster randomised controlled trial.
abstract: BACKGROUND
  Thus far collaborative stepped care (CSC) studies have not incorporated self-help as a first step.
  
  
  OBJECTIVE
  To evaluate the effectiveness of CSC in the treatment of common mental disorders.
  
  
  METHODS
  An 8-month cluster randomised controlled trial comparing CSC to care as usual (CAU) (Dutch Trial Register identifier NTR1224). The CSC consisted of a stepped care approach guided by a psychiatric nurse in primary care with the addition of antidepressants dependent on the severity of the disorder, followed by cognitive-behavioural therapy in mental healthcare.
  
  
  RESULTS
  Twenty general practitioners (GPs) and 8 psychiatric nurses were randomised to provide CSC or CAU. The GPs recruited 163 patients of whom 85% completed the post-test measurements. At 4-month mid-test CSC was superior to CAU: 74.7% (n = 68) v. 50.8% (n = 31) responders (P = 0.003). At 8-month post-test and 12-month follow-up no significant differences were found as the patients in the CAU group improved as well.
  
  
  CONCLUSIONS
  Treatment within a CSC model resulted in an earlier treatment response compared with CAU.
authors.affiliation: Radboud University Nijmegen, Propersona Overwaal Centre for Anxiety Disorders, Nijmegen, The Netherlands. d.oosterbaan@psy.umcn.nl
authors.forename: Desiree B
authors.initials: DB
authors.lastname: Oosterbaan
authors.forename: Marc J P M
authors.initials: MJ
authors.lastname: Verbraak
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.forename: Adriaan W
authors.initials: AW
authors.lastname: Hoogendoorn
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Peyrot
authors.forename: Anna
authors.initials: A
authors.lastname: Muntingh
authors.forename: Anton J L M
authors.initials: AJ
authors.lastname: van Balkom
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011320:Primary Health Care; D012648:Self Care; D016896:Treatment Outcome