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

• Published in: Age and ageing Vol. 41; no. 4; pp. 482 - 488
• Main Authors: van der Weele, Gerda M., de Waal, Margot W. M., van den Hout, Wilbert B., de Craen, Anton J. M., Spinhoven, Philip, Stijnen, Theo, Assendelft, Willem J. J., van der Mast, Roos C., Gussekloo, Jacobijn
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2012; Oxford Publishing Limited (England)
• Subjects: Adaptation, Psychological; Age Factors; Aged; Aged patients; Aged, 80 and over; Aging - psychology; Care and treatment; Causes of; Clinical trials; Cluster Analysis; Cost-Benefit Analysis; Counseling; Depression; Depression (Mood disorder); Depression - diagnosis; Depression - economics; Depression - mortality; Depression - psychology; Depression - therapy; Depression, Mental; Elder care; Elderly patients; Female; General practice; General Practice - economics; Health aspects; Health Care Costs; Health Knowledge, Attitudes, Practice; Health Services for the Aged - economics; House Calls; Humans; Male; Measurement; Medical care; Medical care (Private); Mental depression; Mental Health Services - economics; Mildly; Mortality; Motivation; Netherlands; Older people; Patient Acceptance of Health Care; Patient Education as Topic; Proportional Hazards Models; Psychiatric Status Rating Scales; Quality of life; Referral and Consultation; Severity of Illness Index; Treatment Outcome; Netherlands
• DOI: 10.1093/ageing/afs027
• ISSN: 0002-0729; 1468-2834

to determine (cost)-effectiveness of a stepped-care intervention programme among subjects ≥ 75 years who screened positive for depressive symptoms in general practice. the pragmatic cluster-randomised controlled trial with 12-month follow-up. sixty-seven Dutch general practices. two hundred and thirty-nine subjects ≥ 75 years screened positive for untreated depressive symptoms (15-item Geriatric Depression Scale ≥ 5). 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. 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. 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. www.controlled-trials.com/ISRCTN 71142851v.