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

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]; I2 = 74 %, N = 14. 9-12 months RR = 1.47 [1.23, 1.77], I2 = 80 %, N = 13) and remission rate (4-6 months RR = 1.57 [1.30, 1.90]; I2 = 79 %, N = 14. 12 months RR = 1.60 [1.23, 2.07]; I2 = 94 %, N = 13) as well as anxiety (post-treatment SMD = −0.29 [−0.48, −0.10]; I2 = 0 %, N = 3. 12 months SMD = −0.57 [−0.53, −0.06]; I2 = 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.