title: Feasibility and effectiveness of activity-scheduling as a guided self-help intervention for the prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial.
abstract: BACKGROUND
  Elderly people living in residential homes are at high risk for developing major depressive and anxiety disorders, and therefore deserve attention in terms of preventive interventions. We evaluated the feasibility and effectiveness of a guided self-help intervention for the prevention of depression and anxiety in these residents.
  
  
  METHODS
  We conducted a pragmatic randomized controlled trial in two parallel groups comparing the intervention with usual care in 14 residential homes in and surrounding the city of Amsterdam in the Netherlands. A total of 129 residents with a score of 8 or more on the Centre for Epidemiologic Studies Depression Scale (CES-D) screening instrument, who did not meet the full diagnostic criteria for disorders, and were not suffering from cognitive impairment were recruited between April 2007 and December 2008. Participants were randomized to a guided self-help intervention (n = 67) or to usual care (n = 62). The main outcome measures were improvement in the level of symptoms of depression and anxiety. The secondary outcome was improvement in participation in organized activities in the residential homes. The study is registered in de Dutch Cochrane Centre, under number ISRCTN27540731.
  
  
  RESULTS
  Only 21% of the participants (mean age 84.0 years (SD 6.7), 72.1% suffering from two or more chronic illnesses) completed the intervention. Although we found some large positive effect sizes on the CES-D, none of these effects was statistically significant.
  
  
  CONCLUSIONS
  Although guided self-help may be promising in the prevention of depression and anxiety, it proved to be difficult to apply in this very old and vulnerable group of people living in residential homes.
authors.affiliation: Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Els
authors.initials: E
authors.lastname: Dozeman
authors.forename: Digna J F
authors.initials: DJ
authors.lastname: van Schaik
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
mesh_terms: D000369:Aged, 80 and over; D001007:Anxiety / Q000517:prevention & control*; D003863:Depression / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006299:Health Services for the Aged; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D012648:Self Care / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome