title: Effectiveness of a stepped care intervention for anxiety and depression in people with diabetes, asthma or COPD in primary care: A randomized controlled trial.
abstract: BACKGROUND
  Depression and anxiety are common in people with a chronic somatic disease. Although guidelines recommend stepped care, the effectiveness of this approach has not been evaluated in people with diabetes, asthma, or COPD in primary care.
  
  
  METHODS
  3559 People were sent screening questionnaires (41% response). Of 286 persons with anxiety and/or depression (Generalized Anxiety Disorder questionnaire, GAD-7, cut-off ≥ 8 and/or Patient Health Questionnaire, PHQ-9, cut-off ≥ 7), 46 were randomized into the intervention (stepped care and monitoring of symptoms; n = 23) or control (usual care) group (n = 23). Main outcomes were symptoms of anxiety and depression after the 12-months intervention and six months post intervention. Analysis of covariance was first adjusted for condition and baseline GAD-7/PHQ-9 scores and additionally for age, sex and education.
  
  
  RESULTS
  The intervention group had a significantly lower level of anxiety symptoms at the end of the program (GAD-7 6 ± 6 vs. 9 ± 6; Cohen's d = 0.61). This effect was still present six months post intervention. The effect on depression was statistically significant in the first model (PHQ-9 6 ± 4 vs. 9 ± 6; p = 0.035), but not in the fully adjusted model (p = 0.099), despite a large effect size (d = 0.63). At six months post intervention there was no statistically significant difference in symptoms of depression between the two groups although the difference in symptoms was still clinically significant (Cohen's d = 0.61).
  
  
  CONCLUSIONS
  Many people were screened, but relatively few participated in the randomized controlled trial.
  
  
  CONCLUSIONS
  Stepped care with monitoring resulted in a lower level of symptoms of anxiety and depression in people with a chronic condition.
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: Stoop
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Nefs
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Pommer
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
authors.forename: V J M
authors.initials: VJ
authors.lastname: Pop
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. Electronic address: f.pouwer@tilburguniversity.edu.
authors.forename: F
authors.initials: F
authors.lastname: Pouwer
mesh_terms: D001007:Anxiety / Q000150:complications / Q000628:therapy*; D001249:Asthma / Q000150:complications / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000628:therapy*; D003866:Depressive Disorder; D048909:Diabetes Complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology*; D059020:Suicidal Ideation
keywords: Anxiety; Depression; Diabetes; Lung disease; Randomized controlled trial; Stepped care