Depression and anxiety, an indicated prevention (DIP) protocol in homes for the elderly: feasibility and (cost) effectiveness of a stepped care programme.

Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands. .
BMC Geriatrics (Impact Factor: 2). 02/2007; 7:6. DOI: 10.1186/1471-2318-7-6
Source: PubMed

ABSTRACT Depressive and anxiety disorders are a very common, serious and underdetected 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.

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    ABSTRACT: Elderly persons in residential homes in the Netherlands are at high risk for developing major depressive and anxiety disorders. A stepped-care protocol being used in a study for vulnerable elderly in the community may also be feasible and effective for this group. A pilot study in a residential home in Amsterdam showed more problems than expected in screening and motivating the inhabitants for this intervention protocol. This article describes the problems in our screening procedure. A personal approach, performed by familiar persons, directed at the more independent inhabitants is most likely to succeed. The need for research on effectiveness and feasibility of evidence based methods in residential care remains evident. However, the more vulnerable inhabitants need something else. For this group of inhabitants we need to look more closely to the needs and possibilities by conducting research using a qualitative design.
    Tijdschrift voor gerontologie en geriatrie 06/2008; 39(3):100-106.
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    ABSTRACT: The most common geriatric psychiatric disorder is depression, known to be a multi factorial disorder. However, the influence of common preventable factors is yet to be discovered. This study was designed to evaluate the prevalence of depression and some possible risk factors in elderly residents of nursing homes in Iran. Data on demographic characteristics, nutritional and health status of 244 residents aged 60 years or older were collected from seventeen nursing homes in Tehran, Iran, during 2010 to 2012. Depression was assessed and classified according to the 15-item GDS. Univariate and then multivariate complex sample survey ordinal regression analysis was performed to investigate the association between depression and the risk factors. The average age of the 244 cases studied was 75.8 (±8.7) years, 53.3% were female (of whom 74.2% were housewives), 43.4% illiterate, and 32.0% were divorced or were living separately. The percentages of non-depressed, mild, moderate and severe depression were 9.8%, 50.0%, 29.5% and 10.7%, respectively. Multivariate analysis showed that dissatisfaction with personnel of nursing homes and food quality had odds ratios of 2.91 (1.33-6.36) and 2.64 (1.44-4.87), corresponding to greater odds of having a higher grade depression. Moreover, those who rested or walked had significantly higher risk of a more severe depression in comparison with those who did not (OR of 2.25 (1.50-3.38) and 1.98 (1.24-3.18), respectively), however, studying had a protective odds ratio of 0.17 (0.13-0.22). Depression was very common in our sample and their lifestyle influenced its prevalence.
    Iranian Journal of Public Health 01/2013; 42(6):559-69. · 0.58 Impact Factor
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    ABSTRACT: Š Dozeman E, Van Marwijk HWJ, Van Schaik DJF, Smit F, Stek ML, Van der Horst HE, Bohlmeijer ET, Beekman ATF. Preventie van depressie en angst in verzorgingshuizen. Huisarts Wet 2013;56(4):154-8. Achtergrond Bewoners van verzorgingshuizen vormen een risicogroep voor het ontwikkelen van een depressieve en/of angststoornis. Deze stoornissen komen veel voor en hebben een grote impact op het welzijn en functioneren van de betrokkene, maar worden vaak slecht herkend. Wij vroegen ons af of een stepped-care programma ter preventie van depressieve en angststoornissen in verzorgingshuizen haalbaar en effectief zou kunnen zijn. Methoden In een pragmatische gerandomiseerde gecontroleerde trial vergeleken we de effecten van het programma met gebruikelijke zorg in veertien verzorgingshuizen. In totaal deden 185 bewoners mee, die op de Centre for Epidemiologic Studies Depression Scale (CES-D) minstens 8 punten scoorden, niet leden aan een depressieve of angststoornis en ook niet aan een ernstige cognitieve stoornis. De deelnemers kregen een stepped-care preventieprogramma (n = 93) of gebruikelijke behandeling (n = 92). De deelnemers aan het preventieprogramma kregen eerst een afwachtend beleid en als ze niet opknapten achtereenvolgens een zelfhulpinterventie, een psychologische life-review en een verwijzing naar de huisarts. Onze primaire uitkomstmaat was de incidentie van een depressieve stoornis of angststoornis gedurende het jaar na inclusie. Resultaten De incidentie van depressie en angst samen nam niet af door de interventie: de gecombineerde incidence rate ratio (IRR) was 0,50 (95%-betrouwbaarheidsinterval (BI) 0,23 tot 1,12). Ten opzichte van de gebruikelijke zorg bracht het preventieprogramma wel het indicentierisico voor depressie omlaag (IRR 0,26; 95%-BI 0,12 tot 0,80) maar niet dat voor angst (IRR 1,32; 95%-BI 0,48 tot 3,62). Conclusie De resultaten suggereren dat het toegepaste steppedcare preventieprogramma bij ouderen in verzorgingshuizen wel helpt tegen depressie, maar niet tegen angst.
    Huisarts en wetenschap 04/2013; 56(4).

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