Effectiveness of stepped care for mental health disorders: An umbrella review of meta-analyses

Personalized Medicine in Psychiatry Pub Date : 2024-10-23 DOI:10.1016/j.pmip.2024.100140

Anthony Jeitani , Paul P. Fahey , Michael Gascoigne , Abha Darnal , David Lim

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Abstract

Background

Stepped care offers patients the least intensive intervention required for their mental health needs, with advancements to more intensive treatments as necessary. This umbrella review synthesized existing meta-analyses on the effectiveness of stepped care for mental health disorders.

Methods

PubMed, Embase, Web of Science Core Collection, and PsycINFO were systematically searched for published meta-analyses on the effectiveness of stepped care for mental health disorders since the databases’ inception until August 2023. Protocol was preregistered with PROSPERO (CRD42023461710) and followed the JBI umbrella review methodology.

Results

Ten systematic reviews incorporating 38 primary studies on depression, anxiety and posttraumatic stress disorder were the source of data. In spite of the different models of stepped care, the treatment appeared to improve depression response (3–6 months RR = 1.52 [1.30, 1.78]; I² = 74 %, N = 14. 9–12 months RR = 1.47 [1.23, 1.77], I² = 80 %, N = 13) and remission rate (4–6 months RR = 1.57 [1.30, 1.90]; I² = 79 %, N = 14. 12 months RR = 1.60 [1.23, 2.07]; I² = 94 %, N = 13) as well as anxiety (post-treatment SMD = −0.29 [−0.48, −0.10]; I² = 0 %, N = 3. 12 months SMD = −0.57 [−0.53, −0.06]; I² = 37 %, N = 2).

Limitations

Systematic reviews without meta-analyses and reviews published in languages other than English were not accounted for in this umbrella review.

Conclusions

Our results support the implementation of stepped care, particularly for the pooled effectiveness in depression treatment.

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精神障碍阶梯护理的有效性：荟萃分析综述

背景阶梯式护理为患者提供了满足其心理健康需求所需的强度最低的干预措施，并在必要时提供强度更高的治疗。本综述综合了现有的有关精神疾病阶梯式护理有效性的荟萃分析。方法系统地检索了自数据库建立以来至2023年8月发表的有关精神疾病阶梯式护理有效性的荟萃分析，包括PubMed、Embase、Web of Science Core Collection和PsycINFO。研究协议已在 PROSPERO（CRD42023461710）进行了预先登记，并遵循了 JBI 的总括综述方法。结果数据来源于十篇系统综述，其中包含 38 项关于抑郁症、焦虑症和创伤后应激障碍的主要研究。尽管阶梯式护理的模式各不相同，但治疗似乎改善了抑郁反应（3-6 个月 RR = 1.52 [1.30, 1.78]；I2 = 74 %，N = 14；9-12 个月 RR = 1.47 [1.30, 1.78]；I2 = 74 %，N = 14）。9-12 个月 RR = 1.47 [1.23, 1.77]; I2 = 80 %, N = 13）和缓解率（4-6 个月 RR = 1.57 [1.30, 1.90]; I2 = 79 %, N = 14.12个月RR = 1.60 [1.23, 2.07]；I2 = 94 %，N = 13）以及焦虑（治疗后SMD = -0.29 [-0.48, -0.10]；I2 = 0 %，N = 3；12个月SMD = -0.57 [-0.53, -0.06]；I2 = 37 %，N = 2）。局限性本综述未考虑未进行荟萃分析的系统综述和以英语以外语言发表的综述。结论我们的结果支持实施阶梯式护理，尤其是对抑郁症治疗的综合疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Personalized Medicine in Psychiatry

CiteScore

1.40

自引率

0.00%

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