Does an Outreaching Stepped Care Program Reduce Depressive Symptoms in Community-Dwelling Older Adults? A Randomized Implementation Trial

Beljouw, I.M.J. van; Exel, Eric van; Ven, Peter M. van de; Joling, Karlijn J.; Dhondt, Ton; Stek, Max L.; Marwijk, Harm van

doi:10.1016/j.jagp.2014.09.012

Cited by 12 publications

(21 citation statements)

References 39 publications

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“…Step-Dep is the first study that evaluates the effectiveness of a stepped-care program to prevent MDD in comparison with usual care in patients with DM2 and/or CHD and subthreshold depression in a primary care setting. Our negative findings are in line with preventative stepped-care studies among primary care patients with subthreshold depression and/or anxiety in Hong Kong[ 25 ], in community dwelling older adults[ 23 ], and older adults in general practice[ 24 ], but in contrast with studies in other groups of older adults[ 20 , 21 ], and in visually impaired older adults[ 22 ].…”

Section: Discussionsupporting

confidence: 84%

“…Thirdly, a considerable proportion of patients (29%) did not want to start one or more of the treatment steps. The treatment delivery rates were similar to those in other trials that did not find a significant effect[ 23 – 25 ], but considerably lower than in trials that did find a significant effect on depression outcomes[ 20 – 22 ]. Thus, the uptake of the intervention may have influenced the outcomes.…”

Section: Discussionsupporting

confidence: 78%

“…Offering preventative psychological interventions in a stepped-care format is a possible solution, but the current evidence is both limited and conflicting[ 18 , 19 ]. Whereas some studies on prevention found beneficial effects of stepped-care as compared to usual care on the incidence of depression in the long-term[ 20 – 22 ], other studies found minor and short-term effects[ 23 ], or no beneficial effects at all[ 13 , 24 , 25 ]. Effects also seem to differ in various populations, and across efficacy and effectiveness studies (i.e., under practice circumstances)[ 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial

et al. 2017

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PurposeGiven the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease. We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and/or CHD.MethodsA cluster randomized controlled trial, with 27 primary care centers serving as clusters. A total of 236 DM2 and/or CHD patients with subthreshold depression (nine item Patient Health Questionnaire (PHQ-9) score ≥ 6, no current MDD according to DSM-IV criteria) were allocated to the intervention group (N = 96) or usual care group (n = 140). The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to the general practitioner. The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview (MINI). Secondary outcomes included severity of depression (measured by PHQ-9) at 3, 6, 9 and 12 months.ResultsOf 236 patients (mean age, 67,5 (SD 10) years; 54.7% men), 210 (89%) completed the MINI at 12 months. The cumulative incidence of MDD was 9 of 89 (10.1%) participants in the intervention group and 12 of 121 (9.9%) participants in the usual care group. We found no statistically significant overall effect of the intervention (OR = 1.21; 95% confidence interval (0.12 to 12.41)) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups.ConclusionsThis study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and/or CHD and subthreshold depression.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial

et al. 2017

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“…The above-mentioned suboptimal uptake of and adherence to stepped mental health care and exercise therapy is not uncommon with these type of interventions and study population. Previous trials also experienced suboptimal uptake of and adherence to stepped care interventions for depressive symptoms in older adults [ 38 , 39 ], and in frail older patients [ 40 , 41 ]. A systematic review of Sherrington et al identified 69 trials with exercise interventions to prevent falls in older adults, of which the majority of trials reported moderate to good adherence [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a multifactorial intervention for dizziness in older people in primary care: A cluster randomised controlled trial

et al. 2018

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ObjectivesDizziness is common in older people. Physicians are often unable to identify a specific cause for dizziness in older people, even after an extensive diagnostic work-up. A prognosis-oriented approach, i.e. treating modifiable risk factors for an unfavourable course of dizziness, may reduce dizziness-related impairment in older people in primary care.DesignCluster randomized controlled trial.Setting45 primary care practices in The Netherlands.Participants168 participants aged ≥65y who consulted their general practitioner for dizziness and experienced significant dizziness-related impairment (Dizziness Handicap Inventory (DHI) ≥30). Participants were part of to the intervention group (n = 83) or control group (n = 85), depending on whether they were enlisted in an intervention practice or in a control practice.InterventionsThe multifactorial intervention consisted of: medication adjustment in case of ≥3 prescribed fall-risk-increasing drugs (FRIDs) and/or stepped mental health care in case of anxiety disorder and/or depression and/or exercise therapy in case of impaired functional mobility. The intervention was compared to usual care.Outcome measuresThe primary outcome was dizziness-related impairment. Secondary outcomes were quality of life (QoL), dizziness frequency, fall frequency, anxiety and depression, use of FRIDs.ResultsIntention-to-treat analysis showed no significant intervention effect on dizziness-related impairment (DHI score difference -0.69 [95% CI -5.66;4.28]; p = 0.79). The intervention proved effective in reducing the number of FRIDs (FRID difference -0.48 [95% CI -0.89;-0.06]; p = 0.02). No significant intervention effects were found on other secondary outcomes. The uptake of and adherence to the interventions was significantly lower in patients eligible for ≥2 interventions compared to patients eligible for one intervention (p<0.001).ConclusionsThe multifactorial intervention for dizziness in older patients showed no significant intervention effect on most outcomes and adherence to the multifactorial intervention was low. Although multifactorial treatment for older dizzy people seems promising in theory, we question its feasibility in daily practice. Future research could focus on a sequential treatment for dizziness, e.g. measuring effectiveness of various evidence-based therapies in a stepwise approach.

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“…Despite evidence of the efficacy and effectiveness of the stepped care approach in the clinical field has not been yet reached, positive results have been obtained for preventive treatments aimed at reducing subthreshold depression, which used Internet for individuals who were not able to take part in group interventions (Munoz et al, 1995 ; Willemse et al, 2004 ; Van't Veer-Tazelaar et al, 2009 ; Cuijpers et al, 2010 ). Instead, another recent study (Van Beljouw et al, 2015 ) evaluating an outreaching stepped care program on depressive symptoms in older adults failed to demonstrate the utility of the model, while revealing a single (and not stepped) treatment chosen by the participants being sufficient to achieve positive clinical outcomes.…”

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confidence: 99%

Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis

et al. 2016

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Does an Outreaching Stepped Care Program Reduce Depressive Symptoms in Community-Dwelling Older Adults? A Randomized Implementation Trial

Cited by 12 publications

References 39 publications

Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial

Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial

Effectiveness of a multifactorial intervention for dizziness in older people in primary care: A cluster randomised controlled trial

Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis

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