TOPLINE

Nurse-led collaborative care (CC) did not show noninferiority to guided self-help cognitive-behavioral therapy (GSH-CBT) in reducing perceived stress among primary care patients with stress-related mental ill health. Both groups improved significantly, and these gains persisted at 1 year.

METHODOLOGY

• Researchers randomly assigned 172 patients aged 16 years or older (mean age, 42.3 years; 75% female individuals) with mild-to-moderate stress-related mental ill health at a primary care center in Stockholm to receive either nurse-led CC (n = 85) or GSH-CBT (n = 87).
• CC was a brief program consisting of two to six nurse visits over up to 12 weeks, delivered by two experienced licensed nurses and focused on problem-solving, psychoeducation, and care coordination.
• GSH-CBT used 12 weekly modules or chapters with psychologist support. Of the 87 patients, 51 chose online delivery with written feedback and 36 chose bibliotherapy with face-to-face or video sessions.
• The primary outcome was a change in perceived stress, measured with the 10-item Perceived Stress Scale, from baseline to 12 weeks. Noninferiority required the upper bound of the one-sided 95% CI for the effect size (Cohen's d) to stay below 0.3.
• Secondary outcomes were exhaustion, sleep problems, anxiety, depression, and quality of life. About three quarters of participants had data at the 1-year follow-up.

TAKEAWAY

• The between-group difference in perceived stress reduction favored GSH-CBT (d = 0.22); however, the upper bound of the one-sided 95% CI (0.52) exceeded the margin, so noninferiority was not shown.
• Both groups showed a significant reduction in stress at 12 weeks, from 24.9 to 19.4 with CC and from 25.8 to 18.4 with GSH-CBT; these reductions were sustained at 1 year (16.3 and 15.2, respectively).
• GSH-CBT produced a larger reduction in exhaustion (d = 0.28; 95% CI, 0.64-0.002). Differences in sleep, anxiety, depression, and quality of life were not significant, with effect sizes of 0.07-0.30.
• Participants receiving CC averaged 3.68 nurse sessions vs 4.06 psychologist sessions for those receiving bibliotherapy CBT. Credibility and satisfaction ratings were similar. At least one negative event was reported by 54.2% of participants receiving CC vs 77.3% of those receiving GSH-CBT; none was serious. The groups were not compared statistically.

IN PRACTICE

"As nurse-led CC is safe, relatively easy to administer and yielded significant within-group improvements across all measures, it may still be a useful intervention for this patient group in primary care settings," the authors wrote.

SOURCE

The study was led by Evelina Kontio, Karolinska Institutet, Stockholm, Sweden. It was published online on October 7 in BMJ Mental Health.

LIMITATIONS

This study was limited by the absence of clinician-rated assessments after treatment, the single-center design, and a sample of mostly middle-aged, well-educated women. The lack of an untreated control group limited the interpretation of the observed improvements. GSH-CBT combined two patient-chosen formats, although an exploratory analysis showed near-identical stress trajectories for both, and intention-to-treat analysis may bias results toward noninferiority.

DISCLOSURES

The study was funded by a grant from FORTE. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.