title: Prevention of late-life anxiety and depression has sustained effects over 24 months: a pragmatic randomized trial.
abstract: OBJECTIVE
  Depressive and anxiety disorders in later life have a high incidence and are associated with reduced quality of life. Elsewhere, we demonstrated that a stepped-care prevention approach was successful in halving the incidence of these disorders over a period of 12 months. As a decreasing effect over time is to be expected, our aim was to investigate the longer-term effects.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Thirty-three primary care practices in the Netherlands.
  
  
  METHODS
  One hundred seventy consenting individuals, age 75 years and older, presenting with subthreshold depression or anxiety, not meeting the diagnostic criteria.
  
  
  METHODS
  Participants were randomized to a preventive intervention or usual care. In the first 12 months, the preventive intervention entailed watchful waiting, minimally supported CBT-based self-help intervention, problem-solving treatment, and referral to a primary care physician for medication, if required. In the last 12 months, 95% of the participants ceased to receive such support.
  
  
  METHODS
  Mini International Neuropsychiatric Interview.
  
  
  RESULTS
  The cumulative incidence rate of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depression or anxiety disorder over a period of 24 months was halved by the intervention, from 33 of 84 (39.3%) in the usual care group to 17 of 86 (19.8%) in the intervention group (odds ratio = 0.38; 95% confidence interval = 0.19–0.76), which was significant (z = 2.75; p = 0.006). The corresponding number needed to treat was 5 (95% confidence interval = 3–16).
  
  
  CONCLUSIONS
  A stepped-care approach to the prevention of depression and anxiety in late life was not only successful in halving the incidence of depressive and anxiety disorders after 1 year, but these favorable effects were also sustained over 24 months.
authors.affiliation: Departments of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands. n.vantveer@ggzingeest.nl
authors.forename: Petronella J
authors.initials: PJ
authors.lastname: van't Veer-Tazelaar
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.forename: Patricia
authors.initials: P
authors.lastname: van Oppen
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
mesh_terms: D000369:Aged, 80 and over; D001007:Anxiety / Q000517:prevention & control* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000517:prevention & control* / Q000628:therapy*; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D057832:Watchful Waiting