Department of Psychology, The University of Hong Kong, Hong Kong.
School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
Sci Rep. 2016 Jul 5;6:29281. doi: 10.1038/srep29281.
Stepped care is an increasingly popular treatment model for common mental health disorders, given the large discrepancy between the demand and supply of healthcare service available. In this review, we aim to compare the efficacy and cost-effectiveness of stepped care prevention and treatment with care-as-usual (CAU) or waiting-list control for depressive and/or anxiety disorders. 5 databases were utilized from its earliest available records up until April 2015. 10 randomized controlled trials were included in this review, of which 6 examined stepped care prevention and 4 examined stepped care treatment, specifically including ones regarding depressive and/or anxiety disorders. Only trials with self-help as a treatment component were included. Results showed stepped care treatment revealed a significantly better performance than CAU in reducing anxiety symptoms, and the treatment response rate of anxiety disorders was significantly higher in stepped care treatment than in CAU. No significant difference was found between stepped care prevention/treatment and CAU in preventing anxiety and/or depressive disorders and improving depressive symptoms. In conclusion, stepped care model appeared to be better than CAU in treating anxiety disorders. The model has the potential to reduce the burden on existing resources in mental health and increase the reach and availability of service.
阶梯式护理是一种越来越受欢迎的常见心理健康障碍治疗模式，因为现有的医疗保健服务的需求和供给之间存在很大的差距。在本次综述中，我们旨在比较阶梯式护理预防和治疗与常规护理（CAU）或等待名单对照治疗抑郁和/或焦虑障碍的疗效和成本效益。我们从最早的可用记录到 2015 年 4 月利用了 5 个数据库。本综述纳入了 10 项随机对照试验，其中 6 项研究了阶梯式护理预防，4 项研究了阶梯式护理治疗，具体包括针对抑郁和/或焦虑障碍的研究。仅纳入了包含自助治疗作为治疗组成部分的试验。结果表明，阶梯式护理治疗在减轻焦虑症状方面明显优于 CAU，且阶梯式护理治疗的焦虑障碍治疗反应率明显高于 CAU。在预防焦虑和/或抑郁障碍以及改善抑郁症状方面，阶梯式护理预防/治疗与 CAU 之间未发现显著差异。总之，阶梯式护理模式在治疗焦虑障碍方面似乎优于 CAU。该模式有可能减轻精神卫生现有资源的负担，并增加服务的可及性。
