A stepped care relapse prevention program for depression in older people: a randomized controlled trial

作者：Apil Sachlan R A^*; Hoencamp Erik; Haffmans P M Judith; Spinhoven Philip

来源：International Journal of Geriatric Psychiatry, 2012, 27(6): 583-591.

DOI：10.1002/gps.2756

• cognitive behavior therapy
• effectiveness
• older people
• prevention
• randomized controlled trial
• stepped care

Background: This study aimed to determine the feasibility and the effectiveness of a Stepped Care Program (SCP) for preventing relapse of depression in older people. Stepped care consisted of (1) watchful waiting; (2) bibliotherapy; (3) individual cognitive behavioral therapy; and (4) indicated treatment. Methods: In a randomized controlled trial, persons 55 years and older (n= 136) who had suffered at least one episode of major depression in the past received a SCP or Care As Usual (CAU). The primary outcome measure was incidence of a new depressive episode. Results: Of 1725 previously depressed persons, 175 were willing to partake in the study, 136 of whom were eligible. Treatment satisfaction for stepped care was high. At 12-month follow-up, no difference in incidence of depression between SCP and CAU was found. Medical patient records showed that missing data were often related to relapse. Conclusions: In this study, SCP was not more effective in preventing relapse than CAU. Watchful waiting may harmfully delay actual preventive treatment. Prevention as an integral part of regular treatment might lead to higher participation rates.

• 出版日期2012-6