Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.
Med J Aust. 2010 Jun 7;192(S11):S36-9. doi: 10.5694/j.1326-5377.2010.tb03691.x.
Stepped-care approaches may offer a solution to delivering accessible, effective and efficient services for individuals with depression. In stepped care, all patients commence with a low-intensity, low-cost treatment. Treatment results are monitored systematically, and patients move to a higher-intensity treatment only if necessary. We deliver a stepped-care model targeting patients with depression. The first step consists of "watchful waiting", as half of all patients with a depressive episode recover spontaneously within 3 months. The second step, guided self-help, is the key element of the stepped-care model. Guided self-help, especially when offered through the internet, is effective and cost-efficient. The third step consists of brief face-to-face psychotherapy. Finally, in the fourth step, longer-term face-to-face psychotherapy and antidepressant medication might be considered. Patients are monitored by one person, a care manager, who is responsible for the decision to step up to the next treatment and for continuity of care. The different treatments within the stepped-care model are evidence-based. Data on cost-effectiveness of the full model are still scarce, but we recently demonstrated that the incidence of new cases of depression and anxiety could be halved by introducing stepped care. Effects of web-based guided self-help could be enhanced by incorporating them in a stepped-care model.
阶梯式护理方法可能为提供抑郁症患者可及、有效和高效的服务提供了一种解决方案。在阶梯式护理中，所有患者都从低强度、低成本的治疗开始。系统监测治疗效果，只有在必要时患者才会转至高强度治疗。我们提供一种针对抑郁症患者的阶梯式护理模式。第一步是“静观其变”，因为一半的抑郁发作患者会在 3 个月内自发康复。第二步，即指导自助，是阶梯式护理模式的关键要素。指导自助，尤其是通过互联网提供的指导自助，是有效且具有成本效益的。第三步包括简短的面对面心理治疗。最后，在第四步中，可能会考虑长期的面对面心理治疗和抗抑郁药物治疗。患者由一名护理经理负责监测，该经理负责决定升级到下一个治疗方案，并负责护理的连续性。阶梯式护理模式中的不同治疗方法都有循证依据。关于完整模型的成本效益的数据仍然很少，但我们最近证明，通过引入阶梯式护理，可以将新的抑郁症和焦虑症的发病率减半。将基于网络的指导自助纳入阶梯式护理模式，可以增强其效果。
