Evaluation of STEPS in primary care

Abstract

Background: In Western primary care settings, depression and anxiety feature as one disorder representing the most common form of psychiatric disturbance seen by primary care professionals. Despite this, GP’s fail to recognise the condition in 40% of cases, resulting in many patients receiving inadequate care and poor outcomes.
Objectives: To determine whether a group intervention known as STEPS, would improve the mental health and self-esteem of primary care patients in the absence of accurate psychiatric diagnosis. STEPS is a performance enhancing manualised system based on psychological principles of change, involving eighteen hours of teaching, consisting of video, audio, individual and group participation.
Method: A randomised control trial, cross over design was used. Participants were allocated to the immediate intervention group receiving treatment between Time 1 (T1) and Time 2 (T2) and the delayed intervention group receiving treatment between T2 and T3 (Time 3). Participants consisted of primary care patients experiencing psychological difficulties, self-referrals and some professionals attending the course to enhance their skills. All participants were eighteen years or over. Demographic and psychosocial data was collected by the researcher at T1 and T2. A battery of self-report questionnaires designed to measure self-esteem and current mental state, was completed by participants at T1 prior to the intervention group receiving treatment, at T2 prior to the delayed intervention group receiving treatment and at T3 on completion of treatment.
Results: The findings from Study 1 demonstrate a significant improvement in the mental health and self-esteem of participants in the intervention and the delayed intervention group. The findings from Study 2 also demonstrated a significant improvement in the mental health of participants in the intervention and delayed intervention group. However, improvement in self-esteem of participants in both groups was inconsistent on self-esteem measures. Additionally, baseline scores for the delayed intervention group improved prior to treatment and continued to improve further following treatment.
Conclusions: There was significant improvement in the mental health of participants who completed a STEPS course. Improvement in self-esteem was inconsistent. Promoting the course as a beneficial intervention prior to attendance had therapeutic benefit pre and post treatment. Accurate diagnosis is not a prerequisite to access the therapeutic benefits of STEPS.

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