A minimal psychological intervention in chronically ill elderly patients with depression: a randomized trial.
BACKGROUND
Among older persons with chronic somatic diseases, depression often remains unrecognized and untreated in primary care. The Depression in Elderly with Long-Term Afflictions (DELTA) study aimed to evaluate the effectiveness of a nurse-led minimal psychological intervention (MPI) in chronically ill elderly persons with depression.


METHODS
A randomized controlled trial was conducted, comparing the MPI with usual care in 361 primary care patients. Four nurses had an average of 4 sessions with the intervention patients, each lasting 1 h, over a maximum period of 3 months. Patients were aged 60 years and older, had a minor depression or mild-to-moderate major depression, and either had type II diabetes or chronic obstructive pulmonary disease.


RESULTS
Nine months after the intervention, patients receiving the MPI had significantly fewer depressive symptoms; the intervention patients were also more likely than usual-care controls to show a >or=50% reduction in depressive symptoms relative to baseline values. At 9 months, diabetic MPI patients had a better quality of life than diabetic controls.


CONCLUSIONS
The nurse-led MPI appears to be a feasible and moderately effective method of managing minor-to-moderate depression in chronically ill elderly persons. However, we cannot rule out attention-placebo effects, and the disappointing finding of a recent economic evaluation showing only a 63% chance of the MPI being cost-effective. From a clinical point of view, however, it is of interest to further evaluate adaptations of the MPI, with a stronger emphasis on detection, watchful waiting and mental health problems in general.
Lamers
Femke
F
Department of Social Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands. f.lamers@vumc.nl
Jonkers
Catharina C M
CC
Bosma
Hans
H
Kempen
Gertrudis I J M
GI
Meijer
Jaap A M J
JA
Penninx
Brenda W J H
BW
Knottnerus
J André
JA
van Eijk
Jacques T M
JT
D000368:Aged; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011614:Psychotherapy, Brief / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000379:methods / Q000523:psychology; D012720:Severity of Illness Index; D016896:Treatment Outcome