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Cited by 30Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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

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Jeitani, Anthony, Fahey, Paul P., Gascoigne, Michael, Darnal, Abha, Lim, David·2024·Personalized Medicine in Psychiatry
DOI 10.1016/j.pmip.2024.100140
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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]; I 2 = 74 %, N = 14. 9–12 months RR = 1.47 [1.23, 1.77], I 2 = 80 %, N = 13) and remission rate (4–6 months RR = 1.57 [1.30, 1.90]; I 2 = 79 %, N = 14. 12 months RR = 1.60 [1.23, 2.07]; I 2 = 94 %, N = 13) as well as anxiety (post-treatment SMD = −0.29 [−0.48, −0.10]; I 2 = 0 %, N = 3. 12 months SMD = −0.57 [−0.53, −0.06]; I 2 = 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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  • SMART or hybrid effectiveness-implementation models have already been successful in other chronic conditions.

    “Such models, already successful in other chronic conditions, 138 adjust support dynamically based on need and timing and are well suited to dyadic care, in which patient and caregiver needs may diverge over time. 139 , 140”

    From Nonpharmacologic interventions for managing distress, anxiety, and depression for patients with cancer and their family caregivers: A systematic review and meta‐analysis (2026) · cites this paper as [138]

    The Introduction describes adaptive stepped care, and the results table (Characteristics of included systematic reviews; page unavailable) reports outcomes favoring stepped care for depression in patients who also have diabetes. That supports success for a related adaptive-care approach in a population with a chronic condition, but the paper does not establish that SMART or hybrid effectiveness-implementation models succeeded in treating other chronic conditions. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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2 of the 113 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Aromataris E, Fernandez R, Godfrey C, Holly C, Khalil H, Tungpunkom P. Chapter 10: umbrella reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis: JBI; 2020.
  2. Schünemann HJ, Higgins JPT, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing 'Summary of findings' tables and grading the certainty of the evidence. Cochrane Handbook for Systematic Reviews of Interventions [Internet]. Cochrane. 2023.

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Authors
Jeitani, A., Fahey, P. P., Gascoigne, M., Darnal, A., & Lim, D.
Affiliations
  • Western Sydney University (AU)
  • University of Technology Sydney (AU)
Corresponding author
  • Jeitani, Anthony
  • Fahey, Paul P.
  • Gascoigne, Michael
  • Lim, David
ORCID
Venue
Personalized Medicine in Psychiatry
Publisher
Elsevier BV
Published
2024-11
Volume
47-48
Pages
100140
ISSN
2468-1717 (ISSN-L)
DOI
10.1016/j.pmip.2024.100140
OpenAlex
W4403688036
Cited by
30
References
113
Citations by year
2026: 16 · 2025: 14
FWCI
14.32
Type
journal article
Language
en
Open access
Licence
Locations
Personalized Medicine in Psychiatry (publishedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
stepped care, mental illness, depression, anxiety, post-traumatic stress disorder, treatment effectiveness, depression remission, treatment response, mental health services

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