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A Randomized Controlled Trial

Petronella J. van't Veer-Tazelaar, MA; Harm W. J. van Marwijk, MD, PhD; Patricia van Oppen, PhD; Hein P. J. van Hout, PhD; Henriëtte E. van der Horst, MD, PhD; Pim Cuijpers, PhD; Filip Smit, PhD; Aartjan T. F. Beekman, MD, PhD

Arch Gen Psychiatry. 2009;66(3):297-304.

Context  Given the public health significance of late-life depression and anxiety, and the limited capacity of treatment, there is an urgent need to develop effective strategies to prevent these disorders.

Objective  To determine the effectiveness of an indicated stepped-care prevention program for depression and anxiety disorders in the elderly.

Design  Randomized controlled trial with recruitment between October 1, 2004, and October 1, 2005.

Setting  Thirty-three primary care practices in the northwestern part of the Netherlands.

Participants  A total of 170 consenting individuals, 75 years and older, with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders.

Intervention  Participants were randomly assigned to a preventive stepped-care program (n = 86) or to usual care (n = 84). Stepped-care participants sequentially received a watchful waiting approach, cognitive behavior therapy–based bibliotherapy, cognitive behavior therapy–based problem-solving treatment, and referral to primary care for medication, if required.

Main Outcome Measures  The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview.

Results  The intervention halved the 12-month incidence of depressive and anxiety disorders, from 0.24 (20 of 84) in the usual care group to 0.12 (10 of 86) in the stepped-care group (relative risk, 0.49; 95% confidence interval, 0.24 to 0.98).

Conclusions  Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective.

Trial Registration  isrctn.org Identifier: ISRCTN26474556.

Author Affiliations: Department of General Practice and Institute for Research in Extramural Medicine (Ms van't Veer-Tazelaar and Drs van Marwijk, van Hout, and van der Horst) and Departments of Clinical Psychology (Drs Cuijpers and Smit) and Psychiatry (Drs van Oppen and Beekman), VU University Medical Center, Amsterdam, the Netherlands.

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