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A stepped care relapse prevention program for depression in older people: a randomized controlled trial
- Authors:
- APIL Sachlan R. A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(6), June 2012, pp.583-591.
- Publisher:
- Wiley
The feasibility and the effectiveness of a Stepped Care Program (SCP) for preventing relapse of depression in older people were examined in a randomised controlled trial. Stepped care consisted of watchful waiting; bibliotherapy; individual cognitive behavioural therapy; and indicated treatment. Participants, (n=136, mean age 65.6 years, 72% female), who had suffered at least one episode of major depression in the past, were randomised to receive a SCP or Care As Usual (CAU). They were recruited from a mental health organisation in the Hague. The primary outcome measure was incidence of a new depressive episode. Of 1725 previously depressed persons, 175 were willing to take part in the study, 136 of whom were eligible. Treatment satisfaction with 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. In this study, SCP was not more effective in preventing relapse than CAU. It is suggested that watchful waiting as a first step in SCP may actually cause harm by delaying preventive treatment; prevention as an integral part of regular treatment might lead to higher participation rates.