Doing more with less : concise and standard treatment for depressive and anxiety disorders compared in clinical practice

In this thesis the effectiveness of concise formats of psycho- and/or pharmacotherapy (concise care) in patients suffering from mild to moderate depressive and anxiety disorders in secondary mental health care is evaluated. A pragmatic randomised controlled equivalence trial was set up and carried out as part of routine clinical practice. Evidence for equivalence of concise care compared with standard care was found. Severity of illness was reduced and general health status and subdomains of quality of life improved in both conditions. Moreover, in concise care, the beneficial effects started earlier and patients were more satisfied with overall treatment than patients in standard care. No significant differences in healthcare costs between both treatments were found. In addition, patients suffering from any anxiety disorder (without comorbid depressive disorder) benefitted less from concise care than from standard care. No other clinical or demographic factors were associated with differential treatment effects. Exploring the agreement between a brief screening questionnaire (the Web Screening Questionnaire (WSQ)), and the gold standard diagnostic interview MINI-Plus, reveals that the WSQ is a good screening tool for depressive and anxiety disorders in clinical practice and it might be a further step in the economization and optimization of mental healthcare.