Personalizing psychotherapy based on each patient’s needs (stratified care) appears to be more effective at reducing depression than starting patients on low-intensity psychotherapy and increasing intensity as needed (stepped care), suggests a study in JAMA Psychiatry.
Jaime Delgadillo, Ph.D., of the University of Sheffield in the United Kingdom and colleagues recruited 30 therapists from four health clinics across Northern England for the study. All the participating therapists were part of the Improving Access to Psychological Therapies program and were qualified to deliver low-intensity psychotherapy, which uses principles of cognitive-behavioral therapy (CBT) to teach patients coping skills, typically in group or guided self-help settings.
Delgadillo and colleagues assigned 15 therapists to provide stepped care, during which patients received up to eight 30-minute low-intensity psychotherapy sessions before determining whether high-intensity psychotherapy was needed. High-intensity interventions—which include CBT, person-centered experiential counseling for depression, and more—tend to be longer (one hour as opposed to 30 minutes) and more individualized than low-intensity interventions. The other 15 therapists used a machine learning program that recommended patients to low- or high-intensity therapy based on their mood symptoms, functional impairment, personality traits, employment, and race/ethnicity.
In total, 951 patients seeking treatment for mental disorders including depression, anxiety, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) were enrolled in the study: 583 in the stratified care group and 368 in the stepped care group. The patients completed anywhere from one to 30 therapy sessions, with an average attendance of 7.1 sessions in the stratified care group and 5.8 sessions in the stepped care group. The patients completed both the 9-item Patient Health Questionnaire for depression (PHQ-9) and 7-item Generalized Anxiety Disorder scale (GAD-7) after each session to monitor treatment progress. Disorder-specific measures were unavailable for conditions such as PTSD and OCD, the authors noted.
Overall, 52.3% of the patients who received stratified care achieved a clinically meaningful improvement in their depression (PHQ-9 score of 10 or less and a decrease of at least 6 points) at their last session, compared with 45.1% of the patients who received stepped care. While there was no difference in the anxiety score improvements between the patients in the two groups, a higher percentage of patients in the stratified group achieved what the authors termed “reliable recovery” (which took both GAD-7 scores and PHQ-9 scores into consideration) than those in the stepped care group.
Delgadillo and colleagues estimated the cost of stratified care per patient to be about $332 compared with about $196 for stepped care.
“These findings suggest that stratified care has the potential to improve depression treatment outcomes at a modest incremental cost,” Delgadillo and colleagues wrote.
(Image: iStock/FilippoBacci)
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