Open Access Open Badges Study protocol

Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders

Wike Seekles14*, Annemieke van Straten14, Aartjan Beekman24, Harm van Marwijk34 and Pim Cuijpers14

Author Affiliations

1 Department of Clinical Psychology, VU University, Amsterdam, The Netherlands

2 Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands

3 Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands

4 EMGO institute, VU University Medical Centre, Amsterdam, The Netherlands

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BMC Health Services Research 2009, 9:90  doi:10.1186/1472-6963-9-90

Published: 5 June 2009



Mood and anxiety disorders are highly prevalent and have a large impact on the lives of the affected individuals. Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders. A stepped care program is characterized by different treatment steps that are arranged in order of increasing intensity.


This study is a randomised controlled trial with two conditions: stepped care and care as usual, whereby the latter forms the control group. The stepped care program consists of four evidence based interventions: (1) Watchful waiting, (2) Guided self-help, (3) Problem Solving Treatment and (4) Medication and/or specialized mental health care. The study population consists of primary care attendees aged 18–65 years. Screeners are sent to all patients of the participating general practitioners. Individuals with a Diagnostic and Statistical Manual of mental disorders (DSM) diagnosis of major depression, dysthymia, panic disorder (with or without agoraphobia), generalized anxiety disorder, or social phobia are included as well as individuals with minor depression and anxiety disorders. Primary focus is the reduction of depressive and anxiety symptoms. Both conditions are monitored at 8, 16 and 24 weeks.


This study evaluates the effectiveness of a stepped care program for patients with depressive and anxiety disorder. If effective, a stepped care program can form a worthwhile alternative for care as usual. Strengths and limitations of this study are discussed.

Trial Registration

Current Controlled Trails: ISRCTN17831610.