TY - JOUR
KW - Comorbidity
KW - Depression/therapy
KW - Humans
KW - Primary Health Care/methods
KW - Psychophysiologic Disorders/therapy
KW - Randomized Controlled Trials as Topic
AU - K. Maehder
AU - B. Lowe
AU - M. Harter
AU - D. Heddaeus
AU - M. Scherer
AU - A. Weigel
A1 - 
AB - Background: Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. Objectives: The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. Methods: A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. Results: Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. Conclusions: Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
BT - Family practice
C5 - Medically Unexplained Symptoms
CP - 1
CY - England
DO - 10.1093/fampra/cmy122
IS - 1
JF - Family practice
N2 - Background: Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. Objectives: The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. Methods: A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. Results: Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. Conclusions: Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
PP - England
PY - 2019
SN - 1460-2229; 0263-2136
SP - 38
EP - 52
EP - 
T1 - Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review
T2 - Family practice
TI - Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review
U1 - Medically Unexplained Symptoms
U2 - 30535053
U3 - 10.1093/fampra/cmy122
VL - 36
VO - 1460-2229; 0263-2136
Y1 - 2019
ER -