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


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


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


METHODS
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.


METHODS
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.


METHODS
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.
van't Veer-Tazelaar
Petronella J
PJ
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
van Marwijk
Harm W J
HW
van Oppen
Patricia
P
van Hout
Hein P J
HP
van der Horst
Henriëtte E
HE
Cuijpers
Pim
P
Smit
Filip
F
Beekman
Aartjan T F
AT
D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires