Publications (9) View all
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Article: Preventie van depressie en angst
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ABSTRACT: Bewoners van verzorgingshuizen vormen een hoog- risico groep voor het ontwikkelen van een depressie en/of angststoornis. Deze stoornissen hebben een grote impact, komen veel voor en worden vaak slecht herkend in verzorgingshuizen in Nederland. Een preventieve benadering verdient daarom meer aandacht. Dit artikel beschrijft de opzet van een gerandomiseerd, gecontroleerd onderzoek naar de haalbaarheid en (kosten) effectiviteit van een stepped-care programma met als doel het ontstaan van depressieve- en/of angststoornissen bij bewoners van verzorgingshuizen te voorkomen. De primaire uitkomstmaat van het onderzoek is het ontstaan van een dergelijke stoornis binnen een jaar, met een vervolgmeting na twee jaar. Secundaire uitkomstmaten zijn: symptomen van depressie en angst, kwaliteit van leven, directe gezondheidszorgkosten en tevredenheid met de behandeling. Er is nog weinig onderzoek gedaan naar de effecten van preventieve interventies van psychiatrische problemen bij ouderen. Geïndiceerde preventie door middel van een stepped care programma lijkt echter een veelbelovende aanpak om bewoners en hun verzorgenden te ondersteunen om deze problemen te voorkomen. Dit onderzoek levert een bijdrage aan de kennis op het gebied van preventie van depressie en angst bij ouderen. Mogelijke positieve resultaten kunnen een bijdrage leveren aan het verbeteren van de zorg op dit terrein. Depressive and anxiety disorders are a very common, serious and under detected problem in homes for the elderly. Elderly persons in residential homes are at high risk for developing major depressive and anxiety disorders, and, therefore, deserve attention with regard to prevention. This protocol describes a randomised trial on the feasibility and (cost) effectiveness of a stepped-care programme for prevention of depressive and anxiety disorders in homes for the elderly. The main outcome measure is the incidence of depressive and anxiety disorder in one year with a two years follow up. Secondary outcomes are symptoms of depression and anxiety, quality of life, direct health care costs and satisfaction with treatment. The number of studies examining the effects of preventive interventions on the incidence of mental disorders in the elderly population is very small. However, indicated prevention by means of a stepped-care programme seems to be an important option for decreasing the burden of illness for residents and their caregivers. This study contributes to the body of knowledge in this field. Positive effects may contribute to further use and development of tailored, (cost-) effective and easy to use interventions in a preventive stepped-care programme.05/2012; 33(5):170-173. -
Article: Contradictory effects for prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial.
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ABSTRACT: The aim of this study was to evaluate the effectiveness of a stepped-care program to prevent the onset of depression and anxiety disorders in elderly people living in residential homes. A pragmatic randomized controlled trial was conducted to compare the intervention with usual care in 14 residential homes in the Netherlands. A total of 185 residents with a minimum score of 8 on the Centre for Epidemiologic Studies Depression Scale, who did not meet the diagnostic criteria for a depressive or anxiety disorder, and were not suffering from severe cognitive impairment, were recruited between April 2007 and December 2008. They were randomized to a stepped-care program (N = 93) or to usual care (N = 92). The stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review, and a consultation with the general practitioner. The primary outcome measure was the incidence of a major depressive disorder (MDD) or anxiety disorder during a period of one year according to the Mini International Neuropsychiatric Interview. The intervention was not effective in reducing the incidence of the combined outcome of depression and anxiety (incidence rate ratio (IRR) = 0.50; 95% confidence interval (CI) = 0.23-1.12). However, the intervention was superior to usual care in reducing the risk of MDD incidence (IRR = 0.26; 95% CI = 0.12-0.80) contrary to anxiety incidence (IRR = 1.32; 95% CI = 0.48-3.62). These results suggest that the stepped-care program is effective in reducing the incidence of depression, but is not effective in preventing the onset of anxiety disorders in elderly people living in residential homes.International Psychogeriatrics 03/2012; 24(8):1242-51. · 2.24 Impact Factor -
Article: The center for epidemiological studies depression scale (CES-D) is an adequate screening instrument for depressive and anxiety disorders in a very old population living in residential homes.
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ABSTRACT: The CES-D is an instrument that is commonly used to screen for depression in community-based studies of the elderly, but the characteristics of the CES-D in a residential home population have not yet been studied. The aim of this study was to investigate the criterion validity and the predictive power of the CES-D for both depressive and anxiety disorders in a vulnerable, very old population living in residential homes. Two hundred seventy seven residents were screened with the CES-D, and subsequently interviewed with a diagnostic instrument, the Mini International Neuropsychiatric Instrument (MINI). The sensitivity, specificity, and positive and negative predictive value of the CES-D were calculated by cross-tabulation at different cut-off scores. Receiver Operating Characteristics (ROC) curves were used to assess the optimal cut-off point for each disorder and to asses the predictive power of the instrument. In a residential home population the CES-D had satisfactory criterion validity for depressive disorders and for any combination of depressive and/or anxiety disorders. With a desired sensitivity of at least 80%, the optimal cut-off scores varied between 18 and 22. The predictive power of the CES-D in this population was best for major depression and dysthymia (Area Under the Curve, AUC 0.87), closely followed by the score for any combination of depressive and/or anxiety disorder (AUC 0.86). The use of one single instrument to screen for both depression and anxiety disorders at the same time has obvious advantages in this very old population. The CES-D seems to be a suitable instrument for this purpose.International Journal of Geriatric Psychiatry 03/2011; 26(3):239-46. · 2.42 Impact Factor -
Article: Feasibility and effectiveness of activity-scheduling as a guided self-help intervention for the prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial.
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ABSTRACT: ABSTRACTBackground: Elderly people living in residential homes are at high risk for developing major depressive and anxiety disorders, and therefore deserve attention in terms of preventive interventions. We evaluated the feasibility and effectiveness of a guided self-help intervention for the prevention of depression and anxiety in these residents.Methods: We conducted a pragmatic randomized controlled trial in two parallel groups comparing the intervention with usual care in 14 residential homes in and surrounding the city of Amsterdam in the Netherlands. A total of 129 residents with a score of 8 or more on the Centre for Epidemiologic Studies Depression Scale (CES-D) screening instrument, who did not meet the full diagnostic criteria for disorders, and were not suffering from cognitive impairment were recruited between April 2007 and December 2008. Participants were randomized to a guided self-help intervention (n = 67) or to usual care (n = 62). The main outcome measures were improvement in the level of symptoms of depression and anxiety. The secondary outcome was improvement in participation in organized activities in the residential homes. The study is registered in de Dutch Cochrane Centre, under number ISRCTN27540731.Results: Only 21% of the participants (mean age 84.0 years (SD 6.7), 72.1% suffering from two or more chronic illnesses) completed the intervention. Although we found some large positive effect sizes on the CES-D, none of these effects was statistically significant.Conclusion: Although guided self-help may be promising in the prevention of depression and anxiety, it proved to be difficult to apply in this very old and vulnerable group of people living in residential homes.International Psychogeriatrics 02/2011; · 2.24 Impact Factor -
Article: High incidence of clinically relevant depressive symptoms in vulnerable persons of 75 years or older living in the community.
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ABSTRACT: Clinically relevant depressive symptoms are highly prevalent in people who are 75 years of age or older. However, very old people with a vulnerable health status are under-represented in studies focussing on incidence and risk factors, while the risk of developing depressive symptoms is expected to be very high in this group. The incidence rates of clinically relevant depressive symptoms and their predictors were investigated in a vulnerable elderly population. In a community-based cohort, 651 vulnerable elderly (75+) people were identified by means of the COOP-WONCA charts (Dartmouth Coop Functional Health Assessment Charts/World Organisation of Family Doctors). To study the incidence of clinically relevant symptoms of depression and their predictors, 266 people with no symptoms (Centre for Epidemiologic Studies Depression Scale, CES-D score <16 at baseline) were selected and measured again at six and 18 months. The incidence of clinically relevant symptoms of depression was defined as a CES-D score > or =16, in combination with at least a five-point change between measurements. Logistic regression analyses were applied to determine risk indicators. After 18 months, the incidence rate of all clinically relevant symptoms of depression was 48% (95% confidence interval, CI 44.2-51.8). No specific risk factors were identified within this population. Our estimates of the incidence of depressive symptoms were considerably higher than those previously found in elderly populations living in the community. A vulnerable health status is associated with a high risk of depressive symptoms.Aging and Mental Health 09/2010; 14(7):828-33. · 1.37 Impact Factor
