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Contradictory effects for prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial

Published online by Cambridge University Press:  22 March 2012

Els Dozeman ,
Harm W.J. van Marwijk ,
Digna J.F. van Schaik ,
Filip Smit ,
Max L. Stek ,
Henriëtte E. van der Horst ,
Ernst T. Bohlmeijer  and
Aartjan T.F. Beekman
Els Dozeman*
Affiliation:
Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands EMGO+, Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
Harm W.J. van Marwijk
Affiliation:
Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands EMGO+, Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
Digna J.F. van Schaik
Affiliation:
Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands EMGO+, Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
Filip Smit
Affiliation:
EMGO+, Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
Max L. Stek
Affiliation:
Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
Henriëtte E. van der Horst
Affiliation:
Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands EMGO+, Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
Ernst T. Bohlmeijer
Affiliation:
Department of Psychology, University of Twente, Enschede, The Netherlands
Aartjan T.F. Beekman
Affiliation:
Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands EMGO+, Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
*
Correspondence should be addressed to: Els Dozeman, M.Sc., Department of General Practice, Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Phone: +31-(0)20-4449678; Fax: +31-(0)20-4448361. Email: [email protected].
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Abstract

Background: The aim of this study was to evaluate the effectiveness of a stepped-care program to prevent the onset of depression and anxiety disorders in elderly people living in residential homes.

Methods: A pragmatic randomized controlled trial was conducted to compare the intervention with usual care in 14 residential homes in the Netherlands. A total of 185 residents with a minimum score of 8 on the Centre for Epidemiologic Studies Depression Scale, who did not meet the diagnostic criteria for a depressive or anxiety disorder, and were not suffering from severe cognitive impairment, were recruited between April 2007 and December 2008. They were randomized to a stepped-care program (N = 93) or to usual care (N = 92). The stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review, and a consultation with the general practitioner. The primary outcome measure was the incidence of a major depressive disorder (MDD) or anxiety disorder during a period of one year according to the Mini International Neuropsychiatric Interview.

Results: The intervention was not effective in reducing the incidence of the combined outcome of depression and anxiety (incidence rate ratio (IRR) = 0.50; 95% confidence interval (CI) = 0.23–1.12). However, the intervention was superior to usual care in reducing the risk of MDD incidence (IRR = 0.26; 95% CI = 0.12–0.80) contrary to anxiety incidence (IRR = 1.32; 95% CI = 0.48–3.62).

Conclusions: These results suggest that the stepped-care program is effective in reducing the incidence of depression, but is not effective in preventing the onset of anxiety disorders in elderly people living in residential homes.

Keywords

CES-DHADS-Aresidential care
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Special Issue 8: Focus on late life depression , August 2012 , pp. 1242 - 1251
Copyright
Copyright © International Psychogeriatric Association 2012

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