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.
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 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.