How effective is bibliotherapy for very old adults with subthreshold depression? A randomized controlled trial.
OBJECTIVE
Depressive symptoms are common among elderly primary care patients, and because they encounter considerable barriers in seeking help and they often resist referral to specialized mental health facilities, it is important to look for easily accessible interventions within the primary care setting. Bibliotherapy, which has been found to be effective among younger populations, might be an attractive option. In this study, the authors investigated the effectiveness of bibliotherapy for depressive symptomatology in very old adults.


METHODS
Randomized controlled trial. After a 3-month period of "watchful waiting," the participants were randomly assigned to a bibliotherapy group or a usual care group.


METHODS
Thirty-three general practices in the north-western region of the Netherlands.


METHODS
One hundred seventy community-dwelling adults, aged 75 and older, with subthreshold depression.


METHODS
The bibliotherapy intervention consisted of an information leaflet and a self-help manual "Coping with Depression" adapted for the elderly.


METHODS
Outcome measures after 3 months were a) change in depressive symptoms according to the Center for Epidemiologic Studies Depression Scale (CES-D) and b) the proportion of participants who scored a significant improvement on the CES-D.


RESULTS
One hundred forty-six (85.9%) of the 170 participants completed the baseline and follow-up measurements. The authors did not find any clinically relevant and statistically significant differences between the intervention group and the control group in the severity of the depressive symptoms.


CONCLUSIONS
Bibliotherapy as a stand-alone intervention for the elderly (aged 75 years and older) did not reduce depressive symptoms more than usual care. This might indicate that bibliotherapy can only be effective for patients who are motivated and acknowledge their depression.
Joling
Karlijn J
KJ
Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. k.joling@vumc.nl
van Hout
Hein P J
HP
van't Veer-Tazelaar
Petronella J
PJ
van der Horst
Henriette E
HE
Cuijpers
Pim
P
van de Ven
Peter M
PM
van Marwijk
Harm W J
HW
D000368:Aged; D000369:Aged, 80 and over; D001638:Bibliotherapy / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D012720:Severity of Illness Index; D057832:Watchful Waiting