Stepped care for the treatment of depression: a systematic review and meta-analysis.
J Affect Disord
; 294: 391-409, 2021 11 01.
Article
em En
| MEDLINE
| ID: mdl-34315101
ABSTRACT
BACKGROUND:
The Stepped Care Model (SCM) proposes a sequential approach in the treatment of depression, applying interventions of increasing intensity according to the level of severity of the individual.METHODS:
A systematic review was carried out until January 2020 in eight electronic databases. We included randomized (RCT) and non-randomized controlled trials comparing the SCM to usual non-sequential care.RESULTS:
Eighteen RCT with patients with confirmed or probable depression diagnosis were included. Meta-analyses yielded high heterogeneity, and subgroup analyses showed significant effects of the SCM only in studies with baseline moderately severe symptoms on average, compared to samples with mild/moderate depression. In the former subgroup, effects at 3-6 and 9-12 months were small for symptoms' reduction (g = -0.33, 95%CI -0.55, -0.17 and -0.34, 95%CI -0.53, -0.16) and moderate-to-strong in response and remission (Risk Ratios between 1.70-1.90). Overall, a significant benefit on quality of life was also observed (6 months g = 0.31, 95%CI 0.12, 0.49; 12 months g = 0.18, 95%CI 0.06, 0.31). More patients in the SCM groups were prescribed antidepressants at 6 months (RR = 1.31, 95%CI 1.09, 1.57; I² = 87%).LIMITATIONS:
The search does not guarantee the identification of all the relevant literature. Most included studies show uncertain or high risk of bias.CONCLUSIONS:
The SCM seems to outperform usual care in populations with at least moderately severe symptoms on average. Results show high heterogeneity and future research should explore its sources.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Qualidade de Vida
/
Depressão
Tipo de estudo:
Clinical_trials
/
Systematic_reviews
Aspecto:
Patient_preference
Limite:
Humans
Idioma:
En
Revista:
J Affect Disord
Ano de publicação:
2021
Tipo de documento:
Article