To examine the effectiveness of stepped care in primary care for patients with (mild) mood- and anxiety disorders.
ID
Source
Brief title
Condition
- Other condition
- Psychiatric disorders
Synonym
Health condition
depressieve stemmingsstoornissen en -afwijkingen
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
DSM-IV diagnosis (CIDI), depressive symptoms (QIDS), symptoms of anxiety
(HADS-A).
Secondary outcome
Quality of life (SF36, euroqol), health care use (TIC-P + registrations),
workproductivity (TIC-P), continuity of care (CAHPS/Quote).
Background summary
Mood and anxiety disorders are highly prevalent and have important consequences
on the lives of the affected individuals. Furthermore, they are leading causes
of the burden of disease on a societal level and generate high economic costs.
Therefore, for the individual patients as well as for society in general, it is
crucial that the patients are treated optimally. Currently, there are many
undertreated as well as overtreated patients. The introduction of a stepped
care model in primary care might be a way to enhance care. In stepped care all
patients are offered the same low intensity (evidence based) treatment as a
first step. Only those patients that do not recover, step up to a more
intensive treatment. This corresponds with recent developments in Dutch mental
health care. More and more, social psychiatric nurses (or psychologists) from
mental health institutions work together with a GP in primary care.
Study objective
To examine the effectiveness of stepped care in primary care for patients with
(mild) mood- and anxiety disorders.
Study design
In this RCT participants are recruited by screening primary care patients. All
patients with a positive screen for depression and / or anxiety are screened
again after four weeks. All patients who with a second positive screen are
interviewed by telephone to check in- and exclusioncriteria. All included
patients are randomised to either stepped care or usual care. After 8, 16, and
24 weeks all included patients are asked to fill in questionnaires.
Intervention
Our stepped care model consists of 4 evidence based interventions:
(1) watchful waiting - part of all patients with mood and anxiety disorders
recover spontaneously
(2) one session with a psychiatric nurse / psychologist + bibliotherapy -
bibliotherapy (either by book or through Internet) can be defined as a
standardized psychological treatment which the patient works through
independently at home. The patient is supported by e-mail or telephone
(3) 6 session with a psychiatric nurse / psychologist - short behavioral
intervention consisting of motivational interviewing, activity scheduling en
Problem Solving Treatment
(4) medication and / or a more intensive psychotherapy in a specialised mental
health care setting.
All patients are carefully monitored until they are recovered.
Study burden and risks
Every included patient is interviewed and has to fill in questionnaires. This
might be viewed as a burden. There are no risks involved.
van der Boechorststraat 1
1081 BT Amsterdam
Nederland
van der Boechorststraat 1
1081 BT Amsterdam
Nederland
Listed location countries
Age
Inclusion criteria
adult (18 - 65 year) with DSV-IV disorder: minor depression, major depression, dysthymia, panic disorder (with or without agoraphobia), social phobia, generalised anxiety disorder.
Exclusion criteria
treatment of anxiety or depression in past 6 months
suicide ideation
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL15245.029.06 |