Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Am J Geriatr Psychiatry. 2011 Mar;19(3):256-65. doi: 10.1097/JGP.0b013e3181ec8859.
Depressive symptoms are common among elderly primary care patients, and because they encounter considerable barriers in seeking help and they often resist referral to specialized mental health facilities, it is important to look for easily accessible interventions within the primary care setting. Bibliotherapy, which has been found to be effective among younger populations, might be an attractive option. In this study, the authors investigated the effectiveness of bibliotherapy for depressive symptomatology in very old adults.
Randomized controlled trial. After a 3-month period of "watchful waiting," the participants were randomly assigned to a bibliotherapy group or a usual care group.
Thirty-three general practices in the north-western region of the Netherlands.
One hundred seventy community-dwelling adults, aged 75 and older, with subthreshold depression.
The bibliotherapy intervention consisted of an information leaflet and a self-help manual "Coping with Depression" adapted for the elderly.
Outcome measures after 3 months were a) change in depressive symptoms according to the Center for Epidemiologic Studies Depression Scale (CES-D) and b) the proportion of participants who scored a significant improvement on the CES-D.
One hundred forty-six (85.9%) of the 170 participants completed the baseline and follow-up measurements. The authors did not find any clinically relevant and statistically significant differences between the intervention group and the control group in the severity of the depressive symptoms.
Bibliotherapy as a stand-alone intervention for the elderly (aged 75 years and older) did not reduce depressive symptoms more than usual care. This might indicate that bibliotherapy can only be effective for patients who are motivated and acknowledge their depression.
抑郁症状在老年初级保健患者中很常见，由于他们在寻求帮助时遇到了相当多的障碍，而且往往拒绝转介到专门的精神卫生机构，因此，在初级保健环境中寻找易于获得的干预措施非常重要。已经发现图书疗法对年轻人群有效，可能是一个有吸引力的选择。在这项研究中，作者调查了图书疗法对非常老年患者抑郁症状的有效性。
随机对照试验。经过 3 个月的“观察等待”后，参与者被随机分配到图书疗法组或常规护理组。
荷兰西北部的 33 个普通诊所。
170 名年龄在 75 岁及以上、有亚临床抑郁的社区居住成年人。
图书疗法干预包括一份信息传单和一本为老年人改编的自助手册《应对抑郁》。
3 个月后的结果测量包括：a）根据流行病学研究中心抑郁量表（CES-D）评估的抑郁症状变化；b）CES-D 评分显著改善的参与者比例。
170 名参与者中有 146 名（85.9%）完成了基线和随访测量。作者没有发现干预组和对照组在抑郁症状严重程度方面有任何临床相关和统计学上的显著差异。
作为一种独立的干预措施，图书疗法对老年人（年龄在 75 岁及以上）并没有比常规护理更能减轻抑郁症状。这可能表明，图书疗法只能对有动力并承认自己抑郁的患者有效。
