Stepped care programme in primary care to prevent
anxiety and depression: a randomised clinical trial
SYS Wong1, WK Tang2, WWS Mak3,
FMC Cheung3, S Mercer4, SM Griffiths1, J
Woo5, DTF Lee6, K Kung1, AT Lam7
1 The Jockey Club School of Public
Health and Primary Care, The Chinese University of Hong Kong
2 Department of Psychiatry, Faculty of
Medicine, The Chinese University of Hong Kong
3 Department of Psychology, The Chinese
University of Hong Kong
4 General Practice and Primary Care,
University of Glasgow, Glasgow, United Kingdom
5 Department of Medicine and
Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong
6 The Nethersole School of Nursing, The
Chinese University of Hong Kong
7 New Territories East Cluster, Hospital
Authority, Hong Kong
1. Subthreshold depression and anxiety are
prevalent in primary care. The probability of patients developing
depression or anxiety in 1 year was 13.5%.
2. A stepped care programme was not superior to usual care in terms of preventing onset of depression or anxiety, reducing severity of symptoms, reducing health care utilisation, or improving quality of life in primary care patients with subthreshold depression or anxiety at 12 and 15 months.
3. A watchful waiting period or a less resource-demanding intervention is suggested before initiating further intervention for subthreshold depression or anxiety. Patients considered to be severely depressed or anxious at baseline should be referred to a stepped care programme.
2. A stepped care programme was not superior to usual care in terms of preventing onset of depression or anxiety, reducing severity of symptoms, reducing health care utilisation, or improving quality of life in primary care patients with subthreshold depression or anxiety at 12 and 15 months.
3. A watchful waiting period or a less resource-demanding intervention is suggested before initiating further intervention for subthreshold depression or anxiety. Patients considered to be severely depressed or anxious at baseline should be referred to a stepped care programme.