Stepwise treatment: a progressive model for addressing depression

In the design of health policies focused on psychological care, one of the most prominent strategies is stepped care. This model proposes an organized sequence of interventions classified by their level of intensity, with the aim of optimizing the use of available resources and ensuring responses that are proportional to the characteristics of the disorder detected.

Instead of applying uniform treatments or always starting with intensive solutions, the system allows actions to be adapted according to the severity of the clinical picture. The stepped structure favors immediate intervention, even with low-cost or community-based resources, reserving more specialized procedures for more complex situations.

Levels of the stepped approach

The stepped logic is generally distributed across five progressive stages:

• Level 1: se orienta a la promoción del bienestar y la prevención. Incluye acceso a información sobre salud emocional, estrategias de autocuidado, actividades que fomentan el equilibrio psicosocial y métodos de orientación básica.

• Level 2: contempla respuestas desde el sistema de atención primaria. En este punto se incorporan evaluaciones iniciales, guías de autoayuda estructurada y breves procesos de acompañamiento.

• Level 3: implica un abordaje más profundo, como intervenciones psicoterapéuticas breves, evaluaciones clínicas más completas y el uso de plataformas digitales para el tratamiento psicológico estructurado.

• Level 4: se refiere al ingreso a servicios clínicos especializados, destinados a cuadros más persistentes o complejos. Aquí se desarrollan planes de intervención individualizados, atención en crisis y terapias integrales.

• Level 5: es el más intensivo, destinado a situaciones que requieren internación, tratamientos prolongados o dispositivos altamente especializados con coordinación interdisciplinaria.

Strengths of the model

This system allows resources to be distributed strategically, providing care according to need and avoiding both over-intervention and therapeutic abandonment.

In turn, it facilitates early access to care, which can contribute to a more favorable clinical outcome. The stepped care model also incorporates tools for continuous monitoring and evaluation, allowing the level of intervention to be adjusted if the patient's health status changes.

Classifying cases according to intensity promotes efficiency in the allocation of professionals and technologies and allows for better organization of the healthca