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Importance Depression is a major cause of disability worldwide. Although empirically supported treatments are available, there is scarce evidence on how to effectively personalize psychological treatment selection. Objective To compare the clinical effectiveness and cost-effectiveness of 2 treatment selection strategies: stepped care and stratified care. Design, Setting, and Participants This multisite, cluster randomized clinical trial recruited participants from the English National Health Service from July 5, 2018, to February 1, 2019. Thirty clinicians working across 4 psychological therapy services were randomly assigned to provide stratified (n= 15) or stepped (n= 15) care. In stepped care, patients sequentially access low-intensity guided self-help followed by high-intensity psychotherapy. In stratified care, patients are matched with either low-or high-intensity treatments at initial assessment. Data were analyzed from …