Stratified Care vs. Stepped Care: Which Approach is More Effective for Treating Depression?

Depression is a widespread mental disorder that affects millions of people worldwide. Although there are treatments available, there is limited evidence on how to effectively personalize psychological treatment selection. A clinical study has investigated whether stratified care is a more effective and cost-efficient approach to psychological treatment selection compared with stepped care.

Clinical trial

This cluster randomized clinical trial recruited 951 adults with common mental disorders from the English National Health Service. Thirty clinicians working across 4 psychological therapy services were randomly assigned to provide stratified care or stepped care. In stepped care, patients sequentially access low-intensity guided self-help followed by high-intensity psychotherapy. In stratified care, patients are matched with either low- or high-intensity treatments at initial assessment.

The Results

The study found that stratified care was more effective and cost-effective for the treatment of depression symptoms compared with stepped care. The proportion of cases of posttreatment reliable and clinically significant improvement (RCSI) of depression symptoms was significantly higher in the stratified care group (52.3%) compared with the stepped care group (45.1%). Stratified care was associated with a higher mean additional cost per patient, but this additional cost resulted in an approximately 7% increase in the probability of RCSI.

Implications

These findings suggest that stratified care has the potential to improve depression treatment outcomes at a modest incremental cost. Stratified care is a personalized approach that matches patients with the most appropriate treatment at the initial assessment, potentially reducing the need for sequential low-intensity treatments. This approach could be particularly beneficial for patients who require more intensive treatment.

Conclusion

The study demonstrates that stratified care is an efficacious and cost-effective approach to psychological treatment selection compared with stepped care. It is essential to continue researching and developing personalized approaches to psychological treatment selection to ensure that patients receive the most effective and appropriate treatment for their condition.
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