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Trials
Published in: Trials 1/2011

Open Access 01-12-2011 | Research

Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial

Authors: Wike Seekles, Annemieke van Straten, Aartjan Beekman, Harm van Marwijk, Pim Cuijpers

Published in: Trials | Issue 1/2011

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Abstract

Background

Depressive 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.

Methods

The 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.

Results

Symptoms 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.

Conclusions

In 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 Registration

Current Controlled Trails: ISRCTN17831610.
Appendix
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Metadata
Title
Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial
Authors
Wike Seekles
Annemieke van Straten
Aartjan Beekman
Harm van Marwijk
Pim Cuijpers
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Trials / Issue 1/2011
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-12-171

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