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Arch Gen Psychiatry. 2009 Mar;66(3):297-304. doi: 10.1001/archgenpsychiatry.2008.555.

Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial.

Author information

1
Department of General Practice, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, the Netherlands. pj.vantveer@vumc.nl

Abstract

CONTEXT:

Given the public health significance of late-life depression and anxiety, and the limited capacity of treatment, there is an urgent need to develop effective strategies to prevent these disorders.

OBJECTIVE:

To determine the effectiveness of an indicated stepped-care prevention program for depression and anxiety disorders in the elderly.

DESIGN:

Randomized controlled trial with recruitment between October 1, 2004, and October 1, 2005.

SETTING:

Thirty-three primary care practices in the northwestern part of the Netherlands.

PARTICIPANTS:

A total of 170 consenting individuals, 75 years and older, with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders.

INTERVENTION:

Participants were randomly assigned to a preventive stepped-care program (n = 86) or to usual care (n = 84). Stepped-care participants sequentially received a watchful waiting approach, cognitive behavior therapy-based bibliotherapy, cognitive behavior therapy-based problem-solving treatment, and referral to primary care for medication, if required.

MAIN OUTCOME MEASURES:

The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview.

RESULTS:

The intervention halved the 12-month incidence of depressive and anxiety disorders, from 0.24 (20 of 84) in the usual care group to 0.12 (10 of 86) in the stepped-care group (relative risk, 0.49; 95% confidence interval, 0.24 to 0.98).

CONCLUSIONS:

Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective.

[Indexed for MEDLINE]

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