Prevention of late-life anxiety and depression has sustained effects over 24 months: a pragmatic randomized trial

Departments of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 03/2011; 19(3):230-9.
Source: PubMed


Depressive and anxiety disorders in later life have a high incidence and are associated with reduced quality of life. Elsewhere, we demonstrated that a stepped-care prevention approach was successful in halving the incidence of these disorders over a period of 12 months. As a decreasing effect over time is to be expected, our aim was to investigate the longer-term effects.
Randomized controlled trial.
Thirty-three primary care practices in the Netherlands.
One hundred seventy consenting individuals, age 75 years and older, presenting with subthreshold depression or anxiety, not meeting the diagnostic criteria.
Participants were randomized to a preventive intervention or usual care. In the first 12 months, the preventive intervention entailed watchful waiting, minimally supported CBT-based self-help intervention, problem-solving treatment, and referral to a primary care physician for medication, if required. In the last 12 months, 95% of the participants ceased to receive such support.
Mini International Neuropsychiatric Interview.
The cumulative incidence rate of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depression or anxiety disorder over a period of 24 months was halved by the intervention, from 33 of 84 (39.3%) in the usual care group to 17 of 86 (19.8%) in the intervention group (odds ratio = 0.38; 95% confidence interval = 0.19–0.76), which was significant (z = 2.75; p = 0.006). The corresponding number needed to treat was 5 (95% confidence interval = 3–16).
A stepped-care approach to the prevention of depression and anxiety in late life was not only successful in halving the incidence of depressive and anxiety disorders after 1 year, but these favorable effects were also sustained over 24 months.

Download full-text


Available from: Harm Van Marwijk, Jun 19, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Anxiety is a common mental disorder among older people who live in the Western world, yet little is known about its prevalence in low- and middle-income countries. We investigated the prevalence of anxiety and its correlates among older adults in low- and middle-income countries with diverse cultures. Cross-sectional surveys of all residents aged 65 or over (n = 15 021) in 11 catchment sites in 7 countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru) were carried out as part of the 10/66 collaboration. Anxiety was measured by using the Geriatric Mental State Examination (GMS) and the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) diagnostic algorithm. The age- and gender-standardised prevalence of anxiety varied greatly across sites, ranging from 0.1% (95% CI 0.0-0.3) in rural China to 9.6% (95% CI 6.2-13.1) in urban Peru. Urban centres had higher estimates of anxiety than their rural counterparts with adjusted (age, gender and site) odds ratios of 2.9 (95% CI 1.7-5.3). Age, gender, socioeconomic status and comorbid physical illnesses were all associated with a GMS/AGECAT diagnosis of anxiety, and so was disability (World Health Organization Disability Assessment Schedule II). Anxiety is common in Latin America. Estimates from this region are similar to the ones from high-income European countries found in the literature. As demographic change will occur more rapidly in these countries, further research exploring the mental health of older people in developing areas is vital, with the inclusion of other specific anxiety disorders, along with evidence for strategies for supporting those with these disorders.
    Full-text · Article · Dec 2011 · The British journal of psychiatry: the journal of mental science
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We wanted to determine whether an educational intervention targeting general practitioners reduces the 2-year prevalence of depression and self-harm behavior among their older patients. Our study was a cluster randomized controlled trial conducted between July 2005 and June 2008. We recruited 373 Australian general practitioners and 21,762 of their patients aged 60 years or older. The intervention consisted of a practice audit with personalized automated audit feedback, printed educational material, and 6 monthly educational newsletters delivered over a period of 2 years. Control physicians completed a practice audit but did not receive individualized feedback. They also received 6 monthly newsletters describing the progress of the study, but they were not offered access to the educational material about screening, diagnosis and management of depression, and suicide behavior in later life. The primary outcome was a composite measure of clinically significant depression (Patient Health Questionnaire score ≥10) or self-harm behavior (suicide thoughts or attempt during the previous 12 months). Information about the outcomes of interest was collected at the baseline assessment and again after 12 and 24 months. We used logistic regression models to estimate the effect of the intervention in a complete case analysis and intention-to-treat analysis by imputed chain equations (primary analysis). Older adults treated by general practitioners assigned to the intervention experienced a 10% (95% CI, 3%-17%) reduction in the odds of depression or self-harm behavior during follow-up compared with older adults treated by control physicians. Post hoc analyses showed that the relative effect of the intervention on depression was not significant (OR = 0.93; 95% CI, 0.83-1.03), but its impact on self-harm behavior over 24 months was (OR = 0.80; 95% CI, 0.68-0.94). The beneficial effect of the intervention was primarily due to the relative reduction of self-harm behavior among older adults who did not report symptoms at baseline. The intervention had no obvious effect in reducing the 24-month prevalence of depression or self-harm behavior in older adults who had symptoms at baseline. Practice audit and targeted education of general practitioners reduced the 2-year prevalence of depression and self-harm behavior by 10% compared with control physicians. The intervention had no effect on recovery from depression or self-harm behavior, but it prevented the onset of new cases of self-harm behavior during follow-up. Replication of these results is required before we can confidently recommend the roll-out of such a program into normal clinical practice.
    Full-text · Article · Jul 2012 · The Annals of Family Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Depression is a common and disabling disorder that affects people of all ages and 10% of those older than 65 years. Current strategies to decrease the personal and societal burden of depression in older age rely on the management of people with depression or of those at risk, but benefits have been limited and data remain scant. Existing data suggest that decreasing the onset of a depressive disorder in people at risk is a reasonable way of reducing its prevalence in the community. Older adults with subthreshold symptoms of depression and those who have suffered a stroke have been successfully targeted with various interventions. In addition, the use of collaborative care has improved the immediate and long-term outcome of patients with depression. Finally, the findings of epidemiological studies indicate that a more systematic approach to the management of risk factors might improve the outcome of patients and those at risk, but trial data are still lacking. Current evidence suggests that it is possible to decrease the prevalence of depression in later life, but a more systematic approach to the assessment and management of older adults is necessary.
    No preview · Article · Jul 2012 · Current opinion in psychiatry
Show more

Similar Publications