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

Objectives To examine the effects of an outreaching stepped care intervention program (Lust for Life) compared with usual care on depressive symptoms in older adults living in the community. Design Randomized clinical implementation trial. Setting 18 general practices and a home care organization in...

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Bibliographic Details
Published in:The American journal of geriatric psychiatry 2015-08, Vol.23 (8), p.807-817
Main Authors: van Beljouw, Ilse M.J., M.Sc, van Exel, Eric, Ph.D, van de Ven, Peter M., Ph.D, Joling, Karlijn J., Ph.D, Dhondt, Ton D.F., M.D., Ph.D, Stek, Max L., M.D., Ph.D, van Marwijk, Harm W.J., Ph.D
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cross-Over Studies
Delivery of Health Care
depression
Depression - diagnosis
Depression - therapy
Exercise
Female
General Practitioners
Humans
implementation trial
Internal Medicine
Male
Netherlands
Problem Solving
Referral and Consultation
Severity of Illness Index
stepped care
Treatment Outcome
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Summary:Objectives To examine the effects of an outreaching stepped care intervention program (Lust for Life) compared with usual care on depressive symptoms in older adults living in the community. Design Randomized clinical implementation trial. Setting 18 general practices and a home care organization in the Netherlands. Participants 263 community-dwelling 65+-year-olds with depressive symptoms according to the Patient Health Questionnaire-9 (PHQ-9). Intervention After three months of watchful waiting, participants could sequentially choose between the following evidence-based interventions: 1) guided self-help or an exercise program, 2) problem solving treatment or life review, and 3) a referral to their general practitioner. Measurements The outcome measure was depression severity (PHQ-9), measured every three months over 2 years. Results After the provision of the stepped care program, a significant short-term positive effect on depressive symptoms was found in the first three months after implementation, in which average PHQ-9 scores dropped from 9.34 (SE: 0.61, 95% CI: 8.14–10.5) to 7.83 (SE: 0.51, 95% CI: 6.84–8.81). Conclusions The Lust for Life program has a promising potential to relieve depressive symptoms of older adults in primary care in the short term. Providing one single clinical intervention in accordance with participants' choices instead of stepped care could be sufficient.
ISSN:1064-7481
1545-7214
DOI:10.1016/j.jagp.2014.09.012