TY  - JOUR
T1  - Stepped-care prevention of anxiety and depression in late life: A randomized controlled trial
AU  - van't Veer-Tazelaar PJ, van Marwijk HJ, van Oppen P, et al
Y1  - 2009/03/01
N1  - 10.1001/archgenpsychiatry.2008.555
JO  - Archives of General Psychiatry
SP  - 297
EP  - 304
VL  - 66
IS  - 3
N2  - Context 
    Given the public health significance of late-life depression and anxiety, and the limited capacity of treatment, there is an urgent need to develop effective strategies to prevent these disorders.Objective 
    To determine the effectiveness of an indicated stepped-care prevention program for depression and anxiety disorders in the elderly.Design 
    Randomized controlled trial with recruitment between October 1, 2004, and October 1, 2005.Setting 
    Thirty-three primary care practices in the northwestern part of the Netherlands.Participants 
    A total of 170 consenting individuals, 75 years and older, with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders.Intervention 
    Participants were randomly assigned to a preventive stepped-care program (n = 86) or to usual care (n = 84). Stepped-care participants sequentially received a watchful waiting approach, cognitive behavior therapy–based bibliotherapy, cognitive behavior therapy–based problem-solving treatment, and referral to primary care for medication, if required.Main Outcome Measures 
    The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview.Results 
    The intervention halved the 12-month incidence of depressive and anxiety disorders, from 0.24 (20 of 84) in the usual care group to 0.12 (10 of 86) in the stepped-care group (relative risk, 0.49; 95% confidence interval, 0.24 to 0.98).Conclusions 
    Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective.Trial Registration 
    isrctn.org Identifier: ISRCTN26474556.
SN  - 0003-990X
M3  - doi: 10.1001/archgenpsychiatry.2008.555
UR  - http://dx.doi.org/10.1001/archgenpsychiatry.2008.555
ER  -