title: Preventing depression in homes for older adults: are effects sustained over 2 years?
abstract: OBJECTIVE
  The objective of this study was to evaluate the 2-year effects of a stepped-care programme to prevent the onset of a major depressive disorder (MDD) in older people living in residential homes.
  
  
  METHODS
  A 2-year follow-up study of a pragmatic randomised controlled trial was conducted in 14 residential homes in the Netherlands. A total of 185 residents (Center for Epidemiologic Studies Depression Scale score >7), who did not meet the diagnostic criteria for MDD, were randomised to a stepped-care programme (n = 93) or to usual care (n = 92). Stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review and a consultation with the general practitioner. The primary outcome measure was the incidence of MDD during a period of 2 years, according to the Mini International Neuropsychiatric Interview.
  
  
  RESULTS
  After 2 years, the incidence of MDD was not significantly reduced in the intervention group compared with the control group (incidence rate ratio: 0.98; 95% confidence interval (CI) [0.54, 1.81]). However, in the completer analysis, on the basis of 79 residents who completed the 2-year measurements, there was a significant difference in favour of the intervention group (incidence rate ratio: 0.53; 95% CI [0.32, 0.87]). Dropout percentages were high (44%), mostly accounted for by illness and death (68%).
  
  
  CONCLUSIONS
  A minority of residents had benefit from the intervention that sustained after 2 years in the completer group. Yet, these findings cannot be generalised as the majority of the residents did not opt for participation in the project and many dropped out. Ways should be sought to motivate residents with depressive symptoms to engage in preventive interventions.
authors.affiliation: Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Digna J F
authors.initials: DJ
authors.lastname: van Schaik
authors.forename: Els
authors.initials: E
authors.lastname: Dozeman
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
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: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology
keywords: depression; older; prevention; residential homes