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Table 1 Stepped-care principles of the Depression Quality Improvement Collaborative

From: Implementing a stepped-care approach in primary care: results of a qualitative study

1. Patient differentiation. The general practitioner diagnoses the patient, using the International Classification of Primary Care (ICPC) diagnosis P03 or P76 (Lamberts & Wood, 1990). The clinician classifies the depression to be either severe or non-severe, according to the criteria of the stepped-care model.
2. Stepped treatment. Non-severely depressed patients are offered an intervention of low intensity as a first line treatment, such as: watchful waiting, psycho-education, self-help, counseling, brief psychotherapy, physical exercise. After six to twelve weeks, when response is insufficient, clinicians step up to a next level of intensity, antidepressant medication or cognitive behavioral psychotherapy.
3. Outcome monitoring. The Beck Depression Inventory (BDI), a 21-item self-report inventory, for measuring the severity of depression, is used to monitor symptom severity. A score of 0 to 9 indicates a normal mood, patients with higher scores are monitored every six weeks until the score has returned to normal. Stepping up to higher intensity level treatments is considered in case of insufficient response.