title: Does an outreaching stepped care program reduce depressive symptoms in community-dwelling older adults? A randomized implementation trial.
abstract: OBJECTIVE
  To examine the effects of an outreaching stepped care intervention program (Lust for Life) compared with usual care on depressive symptoms in older adults living in the community.
  
  
  METHODS
  Randomized clinical implementation trial.
  
  
  METHODS
  18 general practices and a home care organization in the Netherlands.
  
  
  METHODS
  263 community-dwelling 65+-year-olds with depressive symptoms according to the Patient Health Questionnaire-9 (PHQ-9).
  
  
  METHODS
  After three months of watchful waiting, participants could sequentially choose between the following evidence-based interventions: 1) guided self-help or an exercise program, 2) problem solving treatment or life review, and 3) a referral to their general practitioner.
  
  
  METHODS
  The outcome measure was depression severity (PHQ-9), measured every three months over 2 years.
  
  
  RESULTS
  After the provision of the stepped care program, a significant short-term positive effect on depressive symptoms was found in the first three months after implementation, in which average PHQ-9 scores dropped from 9.34 (SE: 0.61, 95% CI: 8.14-10.5) to 7.83 (SE: 0.51, 95% CI: 6.84-8.81).
  
  
  CONCLUSIONS
  The Lust for Life program has a promising potential to relieve depressive symptoms of older adults in primary care in the short term. Providing one single clinical intervention in accordance with participants' choices instead of stepped care could be sufficient.
authors.affiliation: Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Ilse M J
authors.initials: IM
authors.lastname: van Beljouw
authors.affiliation: Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: van Exel
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Peter M
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: Department of General Practice, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Joling
authors.affiliation: GGZ Noord-Holland-Noord, Hoorn, The Netherlands.
authors.forename: Ton D F
authors.initials: TD
authors.lastname: Dhondt
authors.affiliation: Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands. Electronic address: m.stek@ggzingeest.nl.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.affiliation: Department of General Practice, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D003695:Delivery of Health Care; D003863:Depression / Q000175:diagnosis* / Q000628:therapy*; D015444:Exercise; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D009426:Netherlands; D011340:Problem Solving; D012017:Referral and Consultation; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Aged; depression; implementation trial; stepped care