StratCare: A multi-site randomised controlled trial of stratified care for depression

Clinical guidelines for the management of depression recommend psychological treatments organised in a stepped care pathway, where patients can access progressively intensive treatments in a sequential way. Stratified care follows principles of precision medicine, and involves selecting the intensity of treatment in a personalised way, based on each patient’s characteristics and expected prognosis.

The StratCare Trial involved 30 clinicians working across four IAPT psychological therapy teams; and they were randomly assigned to a stratified (n=15) or stepped care (treatment as usual, n=15) group. All clinicians used the same interview schedule to conduct assessments with patients seeking treatment for common mental health problems, but those in the stratified care group received a personalised treatment recommendation for each patient – generated by a prognostic machine learning algorithm. In total, n=950 eligible patients received either stratified (n=582) or stepped (n=368) care. The proportions of cases with a full remission of depression (PHQ-9) symptoms were compared between groups. Cost-effectiveness analysis compared treatment costs relative to patient-reported health outcomes.

This seminar will present the findings of the StratCare Trial and discuss implications for theory and practice.