Early interventions for primary care patients with stress-related mental ill health: a randomised controlled non-inferiority trial of a nurse-led collaborative care intervention versus cognitive behavioural therapy.
Evelina Kontio, Victoria Sennerstam, Frank Svärdman et al.
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In 30 seconds
This randomised controlled non-inferiority trial compared nurse-led collaborative care (CC) with psychologist-guided self-help cognitive behavioural therapy (GSH-CBT) in 172 adults with mild to moderate stress-related mental ill health in primary care. Over the 12-week treatment phase, both groups improved on perceived stress and all secondary outcomes. The between-group difference in perceived stress was small and favoured GSH-CBT (d=0.22), but its confidence interval upper bound (0.52) exceeded the prespecified non-inferiority margin of 0.3 d; therefore, CC was not shown to be non-inferior. GSH-CBT also produced a greater reduction in exhaustion.
Key findings
- Both groups had large, significant within-group improvements in perceived stress and all secondary outcomes.
- The perceived-stress difference was d=0.22, favouring GSH-CBT; the confidence interval upper bound (0.52) exceeded the 0.3 d non-inferiority margin.
- Exhaustion improved more with GSH-CBT (d=0.28; 95% CI 0.64 to 0.002); no other between-group differences were observed.
Why it matters
The trial suggests that both approaches can be accompanied by improvement in stress-related symptoms, while it does not establish nurse-led collaborative care as non-inferior to psychologist-guided self-help CBT. This distinction matters when interpreting alternatives intended to extend psychological support in primary care: observed improvement within each group does not demonstrate equivalent effectiveness between interventions.
What to keep in mind
The 12-week treatment phase limits conclusions to short-term outcomes; the abstract does not report longer-term follow-up.