Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
Trials. 2011 Jul 7;12:171. doi: 10.1186/1745-6215-12-171.
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.
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.
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.
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.
Current Controlled Trails: ISRCTN17831610.
抑郁和焦虑障碍在全科医疗中很常见，但往往治疗不足。引入阶梯式护理可能会有所改善。在这项随机试验中，我们检验了这种阶梯式护理模式的有效性。
研究人群包括通过筛查招募的年龄在 18-65 岁之间、患有 DSM-IV 轻度或重度抑郁和/或焦虑障碍的初级保健就诊者。我们将 120 名患者随机分配至阶梯式护理或常规护理组。阶梯式护理方案包括（1）观察等待，（2）指导自助，（3）短期面对面问题解决治疗，以及（4）药物治疗和/或专门的心理健康护理。患者在基线和 8、16 和 24 周时接受评估。
两组患者的抑郁和焦虑症状随时间推移均显著下降。然而，两组之间无统计学显著差异（IDS：P = 0.35，HADS：P = 0.64）。最大但无统计学意义的效应（d = -0.21）出现在 T3 时的焦虑上。在两组中，约有 48%的患者在最终的 6 个月评估中从 DSM-IV 诊断中康复。
总之，我们不能证明在一般实践中，针对抑郁和焦虑的阶梯式护理比常规护理更有效。讨论了可能的原因。
当前对照试验：ISRCTN86507464。
