We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial.
- 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
- 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.Trial registration: www.controlled-trials.com/ISRCTN 71142851v.
- Subjects
NETHERLANDS; PREVENTION of mental depression; EARLY medical intervention; COST effectiveness; MEDICAL referrals; MORTALITY; HEALTH outcome assessment; PRIMARY health care; RESEARCH funding; SCALES (Weighing instruments); RANDOMIZED controlled trials; TREATMENT effectiveness; PROPORTIONAL hazards models; GERIATRIC Depression Scale; DATA analysis software; OLD age; ECONOMICS
- Publication
Age & Ageing, 2012, Vol 41, Issue 4, p482
- ISSN
0002-0729
- Publication type
Article
- DOI
10.1093/ageing/afs027