Prevention of Late-Life Anxiety and Depression Has Sustained Effects Over 24 Months: A Pragmatic Randomized Trial

被引:66
作者
van't Veer-Tazelaar, Petronella J. [1 ]
van Marwijk, Harm W. J. [2 ]
van Oppen, Patricia [1 ]
van der Horst, Henriette E. [2 ]
Smit, Filip [4 ]
Cuijpers, Pim [3 ]
Beekman, Aartjan T. F. [1 ]
机构
[1] Vrije Univ Amsterdam, Med Ctr, Dept Psychiat, EMGO Inst Hlth & Care Res, NL-1081 HL Amsterdam, Netherlands
[2] Vrije Univ Amsterdam, Med Ctr, Dept Gen Practice, EMGO Inst Hlth & Care Res, NL-1081 HL Amsterdam, Netherlands
[3] Vrije Univ Amsterdam, Med Ctr, Dept Psychol, EMGO Inst Hlth & Care Res, NL-1081 HL Amsterdam, Netherlands
[4] Vrije Univ Amsterdam, Med Ctr, Dept Epidemiol & Biostat, EMGO Inst Hlth & Care Res, NL-1081 HL Amsterdam, Netherlands
关键词
Anxiety; depression; geriatric psychiatry; prevention; PRIMARY-CARE; MENTAL-DISORDERS; OLDER-ADULTS; FEASIBILITY; MANAGEMENT; SYMPTOMS; NURSES; DESIGN;
D O I
10.1097/JGP.0b013e3181faee4d
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objective: 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. Design: Randomized controlled trial. Setting: Thirty-three primary care practices in the Netherlands. Participants: One hundred seventy consenting individuals, age 75 years and older, presenting with subthreshold depression or anxiety, not meeting the diagnostic criteria. Intervention: 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. Measurements: Mini International Neuropsychiatric Interview. Results: 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). Conclusions: 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. (Am J Geriatr Psychiatry 2011;19:230-239)
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页码:230 / 239
页数:10
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