Abstract
BackgroundDepressive 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.MethodsThe 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.ResultsSymptoms 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.ConclusionsIn 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.Trial RegistrationCurrent Controlled Trails: ISRCTN17831610.
Highlights
Depressive and anxiety disorders are common in general practice but not always treated adequately
Demographics Participants Mean age, years (SD) Gender With a paid job Born in The Netherlands Married Clinical status Depression (IDS, mean (SD)) Anxiety (HADS, mean (SD))a
This problem could be eliminated with referral through the general practitioner (GP) by referring patients that would benefit from a stepped care model and refer patients with chronic mental problems to specialized mental health care
Summary
Depressive and anxiety disorders are common in general practice but not always treated adequately. Depressive and anxiety disorders are common in general practice [1]. Evidence based clinical guidelines are available for the treatment of depressive and anxiety disorders in primary care [7,8], initiation of, and adherence to effective treatment is usually poor [9,10,11,12]. For depression approximately half of all patients are not recognized by their general practitioner (GP) as having psychological problems [14,15]. For anxiety disorders this is about 75% [16]. Another problem is that most patients who do receive treatment, receive antidepressants [17,18,19], whilst
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