***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Thus far collaborative stepped care ( CSC ) studies have not incorporated self-help as a first step . AIMS To evaluate the effectiveness of CSC  in the treatment of common mental disorders . METHOD An 8-month cluster r and omised controlled trial comparing CSC to care as usual ( CAU ) ( Dutch Trial Register identifier NTR1224 ) . The CSC consisted of a stepped care approach guided by a psychiatric nurse in primary care with the addition of antidepressants dependent on the severity of the disorder , followed by cognitive-behavioural therapy in mental healthcare . RESULTS Twenty general practitioners ( GPs ) and 8 psychiatric nurses were r and omised to provide CSC or CAU . The GPs recruited 163 patients of whom 85 % completed the post-test measurements . At 4-month mid-test CSC was superior to CAU : 74.7 % ( n = 68 ) v. 50.8 % ( n = 31 ) responders ( P = 0.003 ) . At 8-month post-test and 12-month follow-up no significant differences were found as the patients in the CAU group improved as well . CONCLUSIONS Treatment within a CSC model result ed in an earlier treatment response compared with CAU BACKGROUND Panic disorder is a prevalent , often disabling condition among patients in the primary care setting . Although numerous studies have assessed the effectiveness of treatments for depression in primary care , few such studies have been conducted for panic disorder . OBJECTIVE To implement and test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder tailored to the primary care setting . DESIGN R and omized , controlled study comparing intervention to treatment as usual . SETTING Six primary care clinics associated with 3 university medical schools , serving an ethnically and socioeconomically diverse patient population . PARTICIPANTS Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder . Comorbid mental and physical disorders were permitted , provided these did not contraindicate the treatment to be provided and were not acutely life threatening . INTERVENTION Patients were r and omized to receive either treatment as usual or an intervention consisting of a combination of up to 6 sessions ( across 12 weeks ) of cognitive-behavioral therapy ( CBT ) modified for the primary care setting , with up to 6 follow-up telephone contacts during the next 9 months , and algorithm-based pharmacotherapy provided by the primary care physician with guidance from a psychiatrist . Behavioral health specialists , the majority inexperienced in CBT for panic disorder , were trained to deliver the CBT and coordinated overall care , including pharmacotherapy . MAIN OUTCOMES MEASURES Proportion of subjects remitted ( no panic attacks in the past month , minimal anticipatory anxiety , and agoraphobia subscale score < 10 on Fear Question naire ) and responding ( Anxiety Sensitivity Index score < 20 ) and change over time in World Health Organization Disability Scale and short form 12 scores . RESULTS The combined cognitive-behavioral and pharmacotherapeutic intervention result ed in sustained and gradually increasing improvement relative to treatment as usual , with significantly higher rates at all points of both the proportion of subjects remitted ( 3 months , 20 % vs 12 % ; 12 months , 29 % vs 16 % ) and responding ( 3 months , 46 % vs 27 % ; 12 months , 63 % vs 38 % ) and significantly greater improvements in World Health Organization Disability Scale ( all points ) and short form 12 mental health functioning ( 3 and 6 months ) scores . These effects were obtained in spite of similar rates of delivery of guideline -concordant pharmacotherapy to the 2 groups . CONCLUSION Delivery of evidence -based CBT and medication using the collaborative care model and a CBT-naive , midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder OBJECTIVES to determine (cost)-effectiveness of a stepped-care intervention programme among subjects ≥ 75 years who screened positive for depressive symptoms in general practice . DESIGN the pragmatic cluster-r and omised controlled trial with 12-month follow-up . SETTING sixty-seven Dutch general practice s. SUBJECTS two hundred and thirty-nine subjects ≥ 75 years screened positive for untreated depressive symptoms ( 15-item Geriatric Depression Scale ≥ 5 ) . METHODS usual care ( 34 practice s , 118 subjects ) was compared with the stepped-care intervention ( 33 practice s , 121 subjects ) consisting of three steps : individual counselling ; Coping with Depression course ; and -if indicated-referral back to general practitioner to discuss further treatment . Measurements included severity of depressive symptoms [ Montgomery-Åsberg Depression Rating Scale ( MADRS ) ] , quality of life , mortality and costs . RESULTS at baseline subjects mostly were mildly/moderately depressed . At 6 months MADRS scores had improved more in the usual care than the intervention group ( -2.9 versus -1.1 points , P=0.032 ) , but not at 12 months ( -3.1 versus -4.6 , P=0.084 ) . No significant differences were found within two separate age groups ( 75 - 79 years and ≥ 80 years ) . In intervention practice s , 83 % accepted referral to the stepped-care programme , and 19 % accepted course participation . The control group appeared to have received more psychological care . CONCLUSIONS among older subjects who screened positive for depressive symptoms , an offered stepped-care intervention programme  was not (cost)-effective compared with usual care , possibly due to a low uptake of the course offer . TRIAL REGISTRATION www.controlled-trials.com/IS RCT N 71142851v Background Depression is common in primary care and is often unrecognized and untreated . Studies are needed to demonstrate the feasibility of implementing evidence -based depression care provided by primary health care workers ( PHCWs ) in sub-Saharan Africa . We carried out a pilot two-parallel arm cluster r and omized controlled trial of a package of care for depression in primary care . Methods Six primary health care centers ( PHCC ) in two Local Government Areas of Oyo State , South West Nigeria were r and omized into 3 intervention and 3 control clinics . Three PHCWs were selected for training from each of the participating clinics . The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation , activity scheduling , problem solving treatment and medication for severe depression . Providers from the control clinics delivered care as usual , enhanced by a refresher training on depression diagnosis and management . Outcome measures Patient ’s Health Question naire ( PHQ-9 ) , WHO quality of Life instrument ( WHOQOL-Bref ) and the WHO disability assessment schedule ( WHODAS ) were administered in the participants ’ home at baseline , 3 and 6 months . Results About 98 % of the consecutive attendees to the clinics agreed to have the screening interview . Of those screened , 284 ( 22.7 % ) were positive ( PHQ-9 score ≥ 8) and 234 gave consent for inclusion in the study : 165 from intervention and 69 from control clinics . The rates of eligible and consenting participants were similar in the control and intervention arms . In all 85.9 % ( 92.8 % in intervention and 83 % in control ) of the participants were successfully administered outcome assessment s at 6 months . The PHCWs had little difficulty in delivering the intervention package . At 6 months follow up , depression symptoms had improved in 73.0 % from the intervention arm compared to 51.6 % control . Compared to the mean scores at baseline , there was improvement in the mean scores on all outcome measures in both arms at six months . Conclusion The results provide support for the feasibility of conducting a fully-powered r and omized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms . Trial registration numberIS RCT N46754188 ( ISRTCN registry at isrtcn.com ) ; registered 23 September 2013 , details of the pilot study added 12/02/2015 Background Depressive and anxiety disorders are common in general practice but not always treated adequately . Introducing stepped care might improve this . In this r and omized trial we examined the effectiveness of such a stepped care model . Methods The study population consisted of primary care attendees aged 18 - 65 years with minor or major DSM-IV depressive and /or anxiety disorders , recruited through screening . We r and omized 120 patients to either stepped care or care as usual . The stepped care program consisted of ( 1 ) watchful waiting , ( 2 ) guided self-help , ( 3 ) short face-to-face Problem Solving Treatment and ( 4 ) pharmacotherapy and /or specialized mental health care . Patients were assessed at baseline and after 8 , 16 and 24 weeks . Results Symptoms of depression and anxiety decreased significantly over time for both groups . However , there was no statistically significant difference between the two groups ( IDS : P = 0.35 and HADS : P = 0.64 ) . The largest , but not significant , effect ( d = -0.21 ) was found for anxiety on T3 . In both groups approximately 48 % of the patients were recovered from their DSM-IV diagnosis at the final 6 months assessment . Conclusions In summary we could not demonstrate that stepped care for depression and anxiety in general practice was more effective than care as usual . Possible reasons are discussed . Trial Registration Current Controlled Trails : IS RCT N17831610 Objective Stepped , collaborative , and coordinated approaches have been proposed as the optimal treatment strategy for somatic symptom and related disorders , but evidence supporting this strategy is lacking . The aim of this study was to assess the effectiveness of a guideline -based health care network for patients who are at high risk of somatoform disorder ( Sofu-Net ) . Methods In a controlled , prospect i ve , observer-blinded cluster cohort study , patients who were at high risk of somatoform disorder were recruited at 18 primary care practice s in the Sofu-Net and at 15 primary care practice s that provided care as usual ( CAU ) .  The primary outcome at 6-month follow-up was the rate at which the patients received mental health treatment since the establishment of Sofu-Net . The secondary outcomes included the patients ' clinical symptom severity . Results A total of 119 patients in the Sofu-Net intervention group and 100 patients in the CAU control group who were at high risk of somatoform disorder were followed for 6 months . A significantly greater proportion of Sofu-Net patients than CAU patients received mental health treatment ( 47.9 % versus 31.0 % ; odds ratio = 1.96 ; 95 % confidence interval , 1.07–3.58 ) . However , the Sofu-Net group did not show greater reductions in clinical symptom burden compared with the CAU group . Conclusions The treatment of somatoform disorders within a guideline -based health care network result ed in increased rates of mental health treatment but failed to improve patient clinical outcomes . Future investigations are needed to investigate the combined value of health care networks with specialized psychotherapy interventions in patients at high risk of somatic symptom and related disorders . Trial Registration : IS RCT N55870770 Background Collaborative care for depression is more effective in improving treatment outcomes than primary care physicians ’ ( PCPs ) usual care ( UC ) . However , few trials of collaborative care have targeted anxiety . Objective To examine the impact and 12-month durability of a central ized , telephone-delivered , stepped collaborative care intervention ( CC ) for treating anxiety disorders across a network of primary care practice s. Design R and omized controlled trial with blinded outcome assessment s. Participants A total of 329 patients aged 18–64 referred by their PCPs in response to an electronic medical record ( EMR ) prompt .  They include 250 highly anxious patients r and omized to either CC or to UC , and 79 moderately anxious patients who were triaged to a watchful waiting ( WW ) cohort and later r and omized if their conditions clinical ly deteriorated . InterventionTwelve months of telephone-delivered CC involving non-mental health professionals who provided patients with basic psycho-education , assessed preferences for guideline -based pharmacotherapy , monitored treatment responses , and informed PCPs of their patients ’ care preferences and progress via the EMR.Main Measures Mental health-related quality of life ( [ HRQoL ] ; SF-36 MCS ) ; secondary outcomes : anxiety ( Hamilton Anxiety Rating Scale [ SIGH-A ] , Panic Disorder Severity Scale ) and mood (PHQ-9).Key Results At 12-month follow-up , highly anxious patients r and omized to CC reported improved mental HRQoL ( effect size [ ES ] : 0.38 [ 95 % CI : 0.13–0.63 ] ; P = 0.003 ) , anxiety ( SIGH-A ES : 0.30 [ 0.05–0.55 ] ; P = 0.02 ) , and mood ( ES : 0.45 [ 0.19–0.71 ] P = 0.001 ) versus UC . These improvements were sustained for 12 months among African-Americans ( ES : 0.70–1.14 ) and men ( ES : 0.43–0.93 ) . Of the 79 WW patients , 29 % met severity criteria for r and omization , and regardless of treatment assignment , WW patients reported fewer anxiety and mood symptoms and better mental HRQ 
    Output:
    
Conclusions Several stepped care models in primary care already account for comorbidities , with depression being the predominant target disorder .