title: A stepped care relapse prevention program for depression in older people: a randomized controlled trial.
abstract: BACKGROUND
  This study aimed to determine the feasibility and the effectiveness of a Stepped Care Program (SCP) for preventing relapse of depression in older people. Stepped care consisted of (1) watchful waiting; (2) bibliotherapy; (3) individual cognitive behavioral therapy; and (4) indicated treatment.
  
  
  METHODS
  In a randomized controlled trial, persons 55 years and older (n = 136) who had suffered at least one episode of major depression in the past received a SCP or Care As Usual (CAU). The primary outcome measure was incidence of a new depressive episode.
  
  
  RESULTS
  Of 1725 previously depressed persons, 175 were willing to partake in the study, 136 of whom were eligible. Treatment satisfaction for stepped care was high. At 12-month follow-up, no difference in incidence of depression between SCP and CAU was found. Medical patient records showed that missing data were often related to relapse.
  
  
  CONCLUSIONS
  In this study, SCP was not more effective in preventing relapse than CAU. Watchful waiting may harmfully delay actual preventive treatment. Prevention as an integral part of regular treatment might lead to higher participation rates.
authors.affiliation: Leiden University Institute of Psychology, Leiden, the Netherlands. sapil@fsw.leidenuniv.nl
authors.forename: Sachlan R A
authors.initials: SR
authors.lastname: Apil
authors.forename: Erik
authors.initials: E
authors.lastname: Hoencamp
authors.forename: P M
authors.initials: PM
authors.lastname: Judith Haffmans
authors.forename: Philip
authors.initials: P
authors.lastname: Spinhoven
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001638:Bibliotherapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011314:Preventive Health Services / Q000379:methods*; D011446:Prospective Studies; D055502:Secondary Prevention; D057832:Watchful Waiting