title: More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes.
abstract: BACKGROUND
  Apathy is common in nursing home (NH) residents and it overlaps with depression. This study examines the effects of a multidisciplinary depression program on apathy and depressive motivational and mood symptoms.
  
  
  METHODS
  Secondary analyses of a stepped-wedge cluster-randomized controlled trial were conducted with six measurements. Sixteen dementia NH units and 17 somatic units were enrolled. In the intervention condition, a program containing depression assessment procedures and multidisciplinary treatment (activating strategies, psychotherapy, and medication) was introduced. Usual care was provided in the control condition. Outcomes were assessed using the 10-item Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia.
  
  
  RESULTS
  Intention-to-treat analyses showed that the whole depression management program reduced apathy in dementia units (p < 0.001; Cohen's d, -0.35), and depressive motivational symptoms in somatic units (p = 0.008; Cohen's d, -0.40). Depressive mood symptoms were not affected in both unit types. The effect on apathy in dementia units was mainly attributed to activating strategies (p < 0.001; Cohen's d, -0.73). The effect on motivational symptoms in somatic units was mainly attributed to psychotherapy (p = 0.002; Cohen's d, -0.80). Apathy worsening was associated with pharmacological depression treatment in both unit types (p = 0.009; Cohen's d, 0.35).
  
  
  CONCLUSIONS
  Depression management may affect apathy and depressive symptoms differently, which underpins the position of apathy as a distinct syndrome. NH professionals can effectively use activating strategies in dementia units, and psychotherapy in somatic units. More research is needed on treating depressive mood symptoms, and on effects of antidepressants in NHs.
authors.affiliation: School of Psychology, Open University of the Netherlands, Heerlen, the Netherlands.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Leontjevas
authors.forename: Steven
authors.initials: S
authors.lastname: Teerenstra
authors.forename: Martin
authors.initials: M
authors.lastname: Smalbrugge
authors.forename: Myrra J F J
authors.initials: MJ
authors.lastname: Vernooij-Dassen
authors.forename: Ernst T
authors.initials: ET
authors.lastname: Bohlmeijer
authors.forename: Debby L
authors.initials: DL
authors.lastname: Gerritsen
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D057565:Apathy; D003131:Combined Modality Therapy; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010348:Patient Care Team; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D011613:Psychotherapy; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents