title: Prevention of anxiety and depression in Chinese: a randomized clinical trial testing the effectiveness of a stepped care program in primary care.
abstract: BACKGROUND
  Despite empirical evidence demonstrating the effectiveness of collaborative stepped care program (SCP) in Western countries, such programs have not been evaluated in the east, which has a different services system structure and cultural nuances in seeking help for mental illness. Furthermore, only a few studies have used SCP for depression and anxiety prevention. We conducted a trial to test its effectiveness in preventing major depressive disorder and generalized anxiety disorder among primary care patients with subthreshold depression and/or anxiety in Hong Kong.
  
  
  METHODS
  Subthreshold depression and/or anxiety patients were randomized into the SCP group (n=121) or care as usual (CAU) group (n=119). The SCP included watchful waiting, telephone counseling, problem solving therapy, and family doctor treatment within one year. The primary outcome was the onset of major depressive disorder or generalized anxiety disorder in 15 months. The secondary outcomes were depressive and anxiety symptoms, quality of life and time absent from work due to any illness.
  
  
  RESULTS
  Survival analysis showed no differences between the SCP and CAU groups (the cumulative probability of onset at 15 month was 23.1% in the SCP group and 20.5% in the CAU group; Hazard Ratio=1.62; 95% Confidence Interval: 0.82-3.18; p=0.16). No significant differences were found in secondary outcomes.
  
  
  CONCLUSIONS
  Sample size might not have been large enough.
  
  
  CONCLUSIONS
  SCP did not show beneficial effect on depression/anxiety prevention compared with CAU in Hong Kong primary care. As a large majority of patients improved overtime without any intervention, we are not able to exclude the possibility that the intervention might be effective. Future studies would need to have a larger sample size and conduct on patients with more severe symptoms or perform a second screening.
authors.affiliation: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China.
authors.forename: De Xing
authors.initials: DX
authors.lastname: Zhang
authors.affiliation: Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, United Kingdom.
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, United Kingdom.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.affiliation: Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Wai Kwong
authors.initials: WK
authors.lastname: Tang
authors.affiliation: Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Winnie Wing Sze
authors.initials: WW
authors.lastname: Mak
authors.affiliation: Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Fanny Mui Ching
authors.initials: FM
authors.lastname: Cheung
authors.affiliation: General Practice and Primary Care, the University of Glasgow, Glasgow, United Kingdom.
authors.forename: Stewart William
authors.initials: SW
authors.lastname: Mercer
authors.affiliation: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China.
authors.forename: Sian Meryl
authors.initials: SM
authors.lastname: Griffiths
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Diana Tze Fan
authors.initials: DT
authors.lastname: Lee
authors.affiliation: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China.
authors.forename: Kenny
authors.initials: K
authors.lastname: Kung
authors.affiliation: Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong, China.
authors.forename: Augustine Tsan
authors.initials: AT
authors.lastname: Lam
authors.affiliation: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China.
authors.forename: Benjamin Hon Kei
authors.initials: BH
authors.lastname: Yip
authors.affiliation: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China. Electronic address: yeungshanwong@cuhk.edu.hk.
authors.forename: Samuel Yeung Shan
authors.initials: SY
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000517:prevention & control* / Q000523:psychology; D003376:Counseling; D003863:Depression / Q000628:therapy; D003865:Major Depressive Disorder / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006723:Hong Kong; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011788:Quality of Life; D055815:Young Adult
keywords: Clinical trials; Depression and anxiety; Health services; Prevention; Primary care