Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands.
Int Psychogeriatr. 2012 Aug;24(8):1242-51. doi: 10.1017/S1041610212000178. Epub 2012 Mar 22.
The aim of this study was to evaluate the effectiveness of a stepped-care program to prevent the onset of depression and anxiety disorders in elderly people living in residential homes.
A pragmatic randomized controlled trial was conducted to compare the intervention with usual care in 14 residential homes in the Netherlands. A total of 185 residents with a minimum score of 8 on the Centre for Epidemiologic Studies Depression Scale, who did not meet the diagnostic criteria for a depressive or anxiety disorder, and were not suffering from severe cognitive impairment, were recruited between April 2007 and December 2008. They were randomized to a stepped-care program (N = 93) or to usual care (N = 92). The stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review, and a consultation with the general practitioner. The primary outcome measure was the incidence of a major depressive disorder (MDD) or anxiety disorder during a period of one year according to the Mini International Neuropsychiatric Interview.
The intervention was not effective in reducing the incidence of the combined outcome of depression and anxiety (incidence rate ratio (IRR) = 0.50; 95% confidence interval (CI) = 0.23-1.12). However, the intervention was superior to usual care in reducing the risk of MDD incidence (IRR = 0.26; 95% CI = 0.12-0.80) contrary to anxiety incidence (IRR = 1.32; 95% CI = 0.48-3.62).
These results suggest that the stepped-care program is effective in reducing the incidence of depression, but is not effective in preventing the onset of anxiety disorders in elderly people living in residential homes.
本研究旨在评估一种阶梯式护理方案对预防居住在养老院的老年人抑郁和焦虑障碍发病的有效性。
本研究采用实用随机对照试验，在荷兰的 14 家养老院中将干预组与常规护理进行比较。共有 185 名中心流行病学研究抑郁量表评分至少为 8 分、未达到抑郁或焦虑障碍诊断标准、且无严重认知障碍的居民入组，他们于 2007 年 4 月至 2008 年 12 月期间被随机分配至阶梯式护理方案组（n = 93）或常规护理组（n = 92）。阶梯式护理方案参与者依次接受观察等待、自助干预、生活回顾和全科医生咨询。主要结局指标为一年内发生重性抑郁障碍（MDD）或焦虑障碍的发生率，采用 Mini 国际神经精神访谈进行评估。
干预组并不能降低抑郁和焦虑合并症的发生率（发病率比（IRR）= 0.50；95%置信区间（CI）= 0.23-1.12）。然而，与焦虑症发病率（IRR = 1.32；95% CI = 0.48-3.62）相比，干预组降低 MDD 发病率的风险（IRR = 0.26；95% CI = 0.12-0.80）更优。
这些结果表明，阶梯式护理方案能有效降低居住在养老院的老年人抑郁的发病率，但对预防焦虑障碍的发病无效。
