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
In brief
Nurse-led stress care failed to establish results comparable to cognitive behavioral therapy
In a trial of 172 adults, both nurse-led collaborative care and psychologist-guided cognitive behavioral therapy improved stress and other symptoms over 12 weeks. Improvements were slightly larger with cognitive behavioral therapy, and the trial could not confirm nurse-led care was no less effective; it may still offer a practical option where psychologists are scarce.
- Journal
- BMJ mental health (Q1)
- Published
- 7 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Evelina Kontio, Victoria Sennerstam, Frank Svärdman, Conrad Samuelsson, Janina Hettman, Nathalie Broman, et al.
- PMID
- 42843928
- DOI
- 10.1136/bmjment-2026-302797
Why clinicians should know about it
- Picked for Family Practice (top studies of the week, 11 October 2026): Nurse‑led collaborative care vs CBT for stress mental health
Abstract
BACKGROUND: Stress-related mental ill health is highly prevalent, and most individuals first seek help in primary care where access to psychological support is often limited. OBJECTIVE: To test whether nurse-led collaborative care (CC) is non-inferior to cognitive behavioural therapy delivered as psychologist-guided self-help (GSH-CBT) in reducing stress for adult primary care patients with stress-related mental ill health. METHODS: A randomised controlled non-inferiority trial where 172 adult primary care patients with mild to moderate stress-related mental ill health were allocated to nurse-led CC or GSH-CBT (1:1). The primary outcome was the Perceived Stress Scale-10 administered every 3 weeks during the 12-week treatment phase. The a priori non-inferiority margin was 0.3 d, requiring the one-sided 95% CI of the effect size to fall within this bound. Secondary outcomes were symptoms of exhaustion, sleep problems, depressive symptoms, general anxiety and quality of life. FINDINGS: In both conditions, participants showed large, significant within-group improvements on the primary outcome and all secondary outcomes. The primary outcome showed a small between-group difference (d=0.22), favouring GSH-CBT, with the CI upper bound (0.52) exceeding the non-inferiority margin. For secondary outcomes, GSH-CBT led to a greater reduction in exhaustion (d=0.28; 95% CI 0.64 to 0.002). No other between-group differences were observed. CONCLUSIONS: Nurse-led CC was not non-inferior to GSH-CBT. Effect differences were small, but improvements were slightly larger in GSH-CBT. CLINICAL IMPLICATIONS: Given that nurse-led CC is safe, easy to administer, and that significant within-group improvements were observed across all measures, this intervention could be a viable option in primary care settings where psychologist-delivered treatment is limited.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.