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

Trials. 2011 Jul 7:12:171. doi: 10.1186/1745-6215-12-171.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Anxiety Agents / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy*
  • Combined Modality Therapy
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Female
  • Health Services Research
  • Humans
  • Male
  • Mental Health Services*
  • Middle Aged
  • Netherlands
  • Patient Compliance
  • Primary Health Care*
  • Problem Solving
  • Psychiatric Status Rating Scales
  • Self Care
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Watchful Waiting
  • Young Adult


  • Anti-Anxiety Agents
  • Antidepressive Agents

Associated data

  • ISRCTN/ISRCTN17831610