Effectiveness of the Coping With Depression (CWD) course for older adults provided by the community-based mental health care system in the Netherlands: a randomized controlled field trial.
BACKGROUND
The Dutch version of the Coping With Depression (CWD) course for older adults has been implemented in the prevention arm of the community-based mental health care system in the Netherlands. The study group included older adults with subclinical depression as well as those with a major depressive disorder; all were enrolled into the course by mental health care professionals. The effectiveness (immediate and long-term) of the course for this heterogeneous population was studied in an effectiveness trial.


METHODS
Participants were self-referred, responding to media announcements. A total of 119 participants aged 55-85 years (69% female), with subclinical depression and major depression, were randomized to either the CWD course (N = 61) or the waiting list (N = 58).


RESULTS
Nine participants dropped out of the course. According to a diagnostic interview based on the DSM-IV, 39% had a major depressive disorder (MDD), 69% had had a previous MDD, and 45% had an anxiety disorder. Older adults in the intervention group showed a significant decrease in depression symptoms. Gains were maintained over 14 months. In the intervention condition 83% had a pre-treatment score > or = 16 on the Center for Epidemiologic Studies Depression Scale (CES-D); at post-treatment 62% still scored > or = 16.


CONCLUSIONS
The course was beneficial for participants with mild or severe depression, and treatment acceptability was high. It should be fitted into a stepped-care protocol that varies intervention intensity according to clinical needs, using the post-treatment level of functioning as an indication for the next step.
Haringsma
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Division of Clinical and Health Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands. haringsma@fsw.leidenuniv.nl
Engels
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GI
Cuijpers
P
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Spinhoven
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P
D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety / Q000534:rehabilitation; D003156:Community Mental Health Services / Q000458:organization & administration*; D003863:Depression / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008875:Middle Aged; D019964:Mood Disorders / Q000534:rehabilitation; D009426:Netherlands; D010353:Patient Education as Topic; D018579:Patient Selection; D011788:Quality of Life; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D014850:Waiting Lists