title: The clinical effectiveness of concise cognitive behavioral therapy with or without pharmacotherapy for depressive and anxiety disorders; a pragmatic randomized controlled equivalence trial in clinical practice.
abstract: BACKGROUND
  Depressive and anxiety disorders contribute to a high disease burden. This paper investigates whether concise formats of cognitive behavioral- and/or pharmacotherapy are equivalent with longer standard care in the treatment of depressive and/or anxiety disorders in secondary mental health care.
  
  
  METHODS
  A pragmatic randomized controlled equivalence trial was conducted at five Dutch outpatient Mental Healthcare Centers (MHCs) of the Regional Mental Health Provider (RMHP) 'Rivierduinen'. Patients (aged 18-65 years) with a mild to moderate anxiety and/or depressive disorder, were randomly allocated to concise or standard care. Data were collected at baseline, 3, 6 and 12 months by Routine Outcome Monitoring (ROM). Primary outcomes were the Brief Symptom Inventory (BSI) and the Web Screening Questionnaire (WSQ). We used Generalized Estimating Equations (GEE) to assess outcomes.
  
  
  RESULTS
  Between March 2010 and December 2012, 182 patients, were enrolled (n=89 standard care; n=93 concise care). Both intention-to-treat and per-protocol analyses demonstrated equivalence of concise care and standard care at all time points. Severity of illness reduced, and both treatments improved patient's general health status and subdomains of quality of life. Moreover, in concise care, the beneficial effects started earlier.
  
  
  CONCLUSIONS
  Concise care has the potential to be a feasible and promising alternative to longer standard secondary mental health care in the treatment of outpatients with a mild to moderate depressive and/or anxiety disorder. For future research, we recommend adhering more strictly to the concise treatment protocols to further explore the beneficial effects of the concise treatment. The study is registered in the Netherlands Trial Register, number NTR2590. Clinicaltrials.gov identifier: NCT01643642.
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands. Electronic address: d.meuldijk@lumc.nl.
authors.forename: D
authors.initials: D
authors.lastname: Meuldijk
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: I V E
authors.initials: IV
authors.lastname: Carlier
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: van Vliet
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van Veen
authors.affiliation: Leiden University Medical Center, Department of Medical Statistics and Bioinformatics, Leiden, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Wolterbeek
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: van Hemert
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: F G
authors.initials: FG
authors.lastname: Zitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011614:Psychotherapy, Brief / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: Concise therapy; Depressive and anxiety disorder; Equivalence trial; Randomized controlled trial; Routine Outcome Monitoring (ROM); Routine secondary mental healthcare