Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers (COMET)

Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers (COMET)

COMET is a health care research project funded by the Federal Ministry for Education and Research (BMBF) that is conducted within the Hamburg network for health care research ( for a period of three years.

Aims of COMET

  • Implementation of an integrative multi-professional network of general practitioners, outpatient psychotherapists and psychiatrists and inpatient facilities
  • Process and outcome evaluation of a collaborative and stepped care model (SCM) for patients with depressive, anxiety, somatoform and/ or alcohol abuse disorders
  • Evaluation of cost effectiveness

Its novelty is the integration of the four most prevalent mental disorders (depressive, anxiety, somatoform, and alcohol abuse disorders) into one SCM model with a special focus on comorbidity. This integration will raise external validity due to greater correspondence with the current health service situation. Based on the multi-professional cooperation of health care providers across different care sectors, an integrated health care network of general practitioners, mental health specialists (psychiatrists, psychotherapists) and inpatient facilities will be established. Evidence-based clinical practice guidelines and pathways of care with treatment options of varying intensity form the clinical and procedural basis of the network, including low-intensity treatments and innovative e-mental health technologies.

The study is a randomized controlled effectiveness trial of a consecutive sample of patients with depressive and/or anxiety and/or somatoform and/or alcohol abuse disorders drawn from primary care (GP practices) and followed with a prospective survey at four time points. The study is intended to recruit a total of 750 patients from 50 primary care practices. A cluster-randomization at the level of participating primary care practices divides the general practitioners into the intervention group, where patients are treated within a multi-professional collaborative and stepped care approach (including low-intensity treatments, direct access to mental health specialists, inpatient care), and the control group, where patients receive standard care (treatment as usual). Data collection is carried out with online questionnaires as well as telephone interviews at four time-standardized measurement points within one year (baseline, 3, 6, and 12 months). The primary outcome is the change in health-related quality of life from baseline to 12-month follow-up. Secondary outcomes include disorder-specific symptom burden, response, remission, functional quality of life and other clinical and psychosocial variables.


Daniela Heddaeus
Universtitätsklinikum Hamburg-Eppendorf
Institut und Poliklinik für Medizinische Psychologie
Martinistr. 52, W26
20246 Hamburg

Phone: +49 (0)40 7410-57558

Current dates

18. Apr 2023

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