Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2014 Feb;29(2):191-7. doi: 10.1002/gps.3989. Epub 2013 Jun 4.
The objective of this study was to evaluate the 2-year effects of a stepped-care programme to prevent the onset of a major depressive disorder (MDD) in older people living in residential homes.
A 2-year follow-up study of a pragmatic randomised controlled trial was conducted in 14 residential homes in the Netherlands. A total of 185 residents (Center for Epidemiologic Studies Depression Scale score >7), who did not meet the diagnostic criteria for MDD, were randomised to a stepped-care programme (n = 93) or to usual care (n = 92). 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 MDD during a period of 2 years, according to the Mini International Neuropsychiatric Interview.
After 2 years, the incidence of MDD was not significantly reduced in the intervention group compared with the control group (incidence rate ratio: 0.98; 95% confidence interval (CI) [0.54, 1.81]). However, in the completer analysis, on the basis of 79 residents who completed the 2-year measurements, there was a significant difference in favour of the intervention group (incidence rate ratio: 0.53; 95% CI [0.32, 0.87]). Dropout percentages were high (44%), mostly accounted for by illness and death (68%).
A minority of residents had benefit from the intervention that sustained after 2 years in the completer group. Yet, these findings cannot be generalised as the majority of the residents did not opt for participation in the project and many dropped out. Ways should be sought to motivate residents with depressive symptoms to engage in preventive interventions.
本研究旨在评估针对居住在养老院的老年人预防重度抑郁症（MDD）发作的阶梯式护理计划的 2 年效果。
对荷兰 14 家养老院进行了一项实用随机对照试验的 2 年随访研究。共有 185 名居民（流行病学研究抑郁量表评分>7）参加了研究，他们不符合 MDD 的诊断标准，被随机分配到阶梯式护理计划（n=93）或常规护理（n=92）。阶梯式护理参与者依次接受观察等待、自助干预、生活回顾和与全科医生的咨询。主要结局测量是在 2 年内发生 MDD 的发生率，根据 Mini 国际神经精神访谈进行评估。
2 年后，与对照组相比，干预组 MDD 的发生率没有显著降低（发病率比：0.98；95%置信区间[0.54,1.81]）。然而，在完成者分析中，基于完成 2 年测量的 79 名居民，干预组有显著的优势（发病率比：0.53；95%置信区间[0.32,0.87]）。脱落率较高（44%），主要由疾病和死亡引起（68%）。
少数居民从干预中受益，这种受益在完成者组中持续了 2 年。然而，由于大多数居民没有选择参与该项目，并且许多人退出了，这些发现不能推广到全体居民。应该寻找方法激励有抑郁症状的居民参与预防干预。
