Cluster Randomized Trial of Stepped Care Intervention vs. Treatment as Usual for Patients With Depression

NCT ID: NCT01731717

Last Updated: 2015-07-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

737 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-09-30

Study Completion Date

2015-05-31

Brief Summary

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The main aim of the project is the implementation and evaluation of a stepped care model (SCM) for patients with depression with 6 treatment options of varying intensity and setting, including innovative technologies (e-mental health, telephone-based psychotherapy). Within this complex intervention, patients are treated by a multiprofessional network of health care providers in Hamburg, Germany. The study compares the SCM condition (intervention group) to a control group receiving treatment as usual (cluster randomization on the level of participating general practitioners). It is expected that the SCM condition will show better results regarding reduction of mental symptoms, improvement of quality of life, more efficient access to care and better cost-benefit ratio.

Detailed Description

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Conditions

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Depression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Stepped care intervention (SCM)

Patients within the stepped care intervention are screened by general physician using the PHQ-9 (inclusion criterion: \>4 points) and diagnosed according to International Classification of Diseases (ICD-10) criteria. Patients receive differentially intensive treatment according to depression severity.

Patients with mild depression receive:

Step I: Active monitoring or Step II: II.a. Bibliotherapy or II.b. Online self-help ("Deprexis®") or II+: Telephone-based psychotherapy

Patients with moderate depression receive:

Step III: III.a. Outpatient psychotherapy or III.b. Psychopharmacological treatment

Patients with severe depression receive:

Step IV: Combined psychotherapy and psychopharmacological treatment, optionally in inpatient setting.

Group Type EXPERIMENTAL

Active monitoring

Intervention Type BEHAVIORAL

General physician performs monitoring every 2 weeks using the PHQ-9 depression scale.

Bibliotherapy

Intervention Type BEHAVIORAL

Patient works with self-help book "Selbsthilfe bei Depressionen" (Görlitz, 2010) under general physician's supervision.

Online self-help

Intervention Type BEHAVIORAL

Patient works with online self-help program "Deprexis" under general physician's supervision.

Outpatient psychotherapy

Intervention Type BEHAVIORAL

Patient receives outpatient psychodynamic or cognitive-behavioural psychotherapy from a psychotherapist participating in the network.

Psychiatric treatment

Intervention Type PROCEDURE

Patient receives treatment from psychiatrist or general physician participating in the network, this includes psychopharmacotherapy. Treatment takes place within routine care, thus psychiatrists or general physicians individually determine the type of medication and are committed to follow the recommendations of the German S3-Guideline/National Disease Management Guideline for Unipolar Depression.

Combined psychotherapy and psychopharmacological treatment

Intervention Type BEHAVIORAL

Patient receives psychotherapy combined with psychopharmacological treatment, if necessary in inpatient setting.

Control group: treatment as usual

Patients in the control group are screened by their general physician using the PHQ-D-9 depression scale. Patients included in the study then receive treatment as usual from general physician or other health service providers.

Group Type ACTIVE_COMPARATOR

Control group: treatment as usual

Intervention Type OTHER

treatment as usual

Interventions

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Active monitoring

General physician performs monitoring every 2 weeks using the PHQ-9 depression scale.

Intervention Type BEHAVIORAL

Bibliotherapy

Patient works with self-help book "Selbsthilfe bei Depressionen" (Görlitz, 2010) under general physician's supervision.

Intervention Type BEHAVIORAL

Online self-help

Patient works with online self-help program "Deprexis" under general physician's supervision.

Intervention Type BEHAVIORAL

Outpatient psychotherapy

Patient receives outpatient psychodynamic or cognitive-behavioural psychotherapy from a psychotherapist participating in the network.

Intervention Type BEHAVIORAL

Psychiatric treatment

Patient receives treatment from psychiatrist or general physician participating in the network, this includes psychopharmacotherapy. Treatment takes place within routine care, thus psychiatrists or general physicians individually determine the type of medication and are committed to follow the recommendations of the German S3-Guideline/National Disease Management Guideline for Unipolar Depression.

Intervention Type PROCEDURE

Combined psychotherapy and psychopharmacological treatment

Patient receives psychotherapy combined with psychopharmacological treatment, if necessary in inpatient setting.

Intervention Type BEHAVIORAL

Control group: treatment as usual

treatment as usual

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* \>4 points on PHQ-D-9 depression scale
* sufficient knowledge of German language
* health situation that allows questionnaire completion

Exclusion Criteria

* insufficient knowledge of German language
* health situation not allowing questionnaire completion
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universitätsklinikum Hamburg-Eppendorf

OTHER

Sponsor Role lead

Responsible Party

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PD Dr. phil. Birgit Watzke

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Birgit Watzke, Prof. Dr.

Role: STUDY_DIRECTOR

Centre for Psychosocial Medicine, Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

Martin Härter, Prof. Dr. Dr.

Role: STUDY_DIRECTOR

Centre for Psychosocial Medicine, Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

Locations

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Centre for Psychosocial Medicine, Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf

Hamburg, City state of Hamburg, Germany

Site Status

Countries

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Germany

References

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Brettschneider C, Heddaeus D, Steinmann M, Harter M, Watzke B, Konig HH. Cost-effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression - a cluster-randomized trial. BMC Psychiatry. 2020 Aug 28;20(1):427. doi: 10.1186/s12888-020-02829-0.

Reference Type DERIVED
PMID: 32859177 (View on PubMed)

Watzke B, Heddaeus D, Steinmann M, Konig HH, Wegscheider K, Schulz H, Harter M. Effectiveness and cost-effectiveness of a guideline-based stepped care model for patients with depression: study protocol of a cluster-randomized controlled trial in routine care. BMC Psychiatry. 2014 Aug 20;14:230. doi: 10.1186/s12888-014-0230-y.

Reference Type DERIVED
PMID: 25182269 (View on PubMed)

Other Identifiers

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01KQ1002B-TP7

Identifier Type: -

Identifier Source: org_study_id

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