Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: The PROMODE randomised controlled trial

Gerda M. Van der Weele, Margot W.M. De Waal, Wilbert B. Van den Hout, Anton J.M. De Craen, Philip Spinhoven, Theo Stijnen, Willem J.J. Assendelft, Roos C. Van der Mast, Jacobijn Gussekloo

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32 Scopus citations

Abstract

Objectives: to determine (cost)-effectiveness of a stepped-care intervention programme among subjects ≥75 years who screened positive for depressive symptoms in general practice. Design: the pragmatic cluster-randomised controlled trial with 12-month follow-up. Setting: sixty-seven Dutch general practices. Subjects: two hundred and thirty-nine subjects ≥75 years screened positive for untreated depressive symptoms (15-item Geriatric Depression Scale ≥5).Methods: usual care (34 practices, 118 subjects) was compared with the stepped-care intervention (33 practices, 121 subjects) consisting of three steps: individual counselling; Coping with Depression course; and-if indicated-referral back to general practitioner to discuss further treatment. Measurements included severity of depressive symptoms [Montgomery-Åsberg Depression Rating Scale (MADRS)], quality of life, mortality and costs. Results: at baseline subjects mostly were mildly/moderately depressed. At 6 months MADRS scores had improved more in the usual care than the intervention group (-2.9 versus -1.1 points, P = 0.032), but not at 12 months (-3.1 versus -4.6, P = 0.084). No significant differences were found within two separate age groups (75-79 years and ≥80 years). In intervention practices, 83% accepted referral to the stepped-care programme, and 19% accepted course participation. The control group appeared to have received more psychological care. Conclusions: among older subjects who screened positive for depressive symptoms, an offered stepped-care intervention programme was not (cost)-effective compared with usual care, possibly due to a low uptake of the course offer.

Original languageEnglish
Article numberafs027
Pages (from-to)482-488
Number of pages7
JournalAge and Ageing
Volume41
Issue number4
DOIs
StatePublished - Jul 2012
Externally publishedYes

Keywords

  • Cost-utility
  • Depressive symptoms
  • Elderly
  • Oldest old
  • Primary healthcare
  • Screening
  • Stepped-care intervention

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