With the increasing demands being placed on primary care, the growing numbers of people with diabetes and the high prevalence of co-morbid depression, it is equally important that patients who screen positive are managed appropriately and efficiently. Stepped care models build on the efficiency model where by the least restrictive and least costly interventions are provided prior to higher intensity care. This reduces the risk of those people not in need of intensive treatment receiving too much care whilst ensuring that sufficient care
is provided to all patients. Since the detection and treatment of minor depression has been shown to prevent severe depression and is cost saving, the starting point for the ideal depression stepped care model is a highly sensitive screening tool. Having identified depression, the stepped care model can subsequently guide management ranging from watchful waiting to collaborative care and/or referral to mental
health services for more severely depressed patients (Fig. 1). Fortunately, about 30–40% of patients recover fromdepression without intervention. This means that it would be inefficient and unnecessary to provide all individuals with active treatment. The first step for people with minor depression is, therefore, to monitor symptoms over the course of the ensuing 8–12-weeks and then re-evaluate. This watchful waiting
does not, however, preclude providing patients with advice and information on how to stay physically and mentally fit