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Effectiveness of indicated prevention of depression and anxiety in residents of homes for the elderly with symptoms

Projectomschrijving

Effectiveness of indicated prevention of depression and anxiety in residents of homes for the elderly with symptoms

Bewoners van verzorgingshuizen hebben vaak verschillende beperkingen die het gevolg zijn van ouder worden. Bij de behandeling en zorg ligt vaak de nadruk op de lichamelijke problemen. Daardoor worden psychische problemen, zoals depressie en angst, onvoldoende (h)erkend. Extra ondersteuning kan echter voorkomen dat bewoners met lichte psychische klachten, een stoornis ontwikkelen. In dit onderzoek is bestudeerd of een programma die zulke stapsgewijze extra ondersteuning aanbiedt, de psychische problemen daadwerkelijk voorkomt. Het blijkt dat bewoners die volgens dit programma werden begeleid, inderdaad minder kans hadden op het krijgen van een depressie. Het programma had geen effect op angststoornissen. De conditie of motivatie van veel bewoners was echter onvoldoende om het begeleidingsprogramma vol te houden. Het programma is daarom alleen geschikt voor een selecte groep bewoners. Voor anderen moet het programma verder worden aangepast.

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Samenvatting van de aanvraag

BACKGROUND: indicated prevention, as opposed to universal or selective prevention, aims to counter the onset or development of a disorder in those who already have symptoms. In homes for the elderly, psychiatric illnesses, mostly depressive and anxiety disorders, are now very common and have an enormous impact on well-being and daily functioning. Indicated prevention of these conditions may be as effective in later life as it is in younger adults. Of the five current priorities of ZONmw Prevention Programme, we aim to address three (chronic illness, anxiety and depression, and organisation), in a new demonstration project in an underexplored and highly relevant setting: the home for the elderly. OBJECTIVE: to evaluate the effects and costs of indicated prevention by a multicomponent, demand-led stepped care programme (SC), compared to usual care (UC). DESIGN: Randomised controlled trial to evaluate overall effects of the package in practice. SETTING: Homes for the elderly. PARTICIPANTS: residents with depressive or anxious symptoms, i.e., a score of 16 or more on the validated self-report Centre for Epidemiological Studies Depression scale (CES-D) who wish further monitoring. INTERVENTION: trained home care nurses apply the already developed Resident Assessment Instrument for Home Care (RAI-HC), to which we have added the CES-D. Subjects are randomised to a generic SC programme (demonstration project 1 'Prevention of anxiety and depression in later life programme(9607.091.1))' or usual care. OUTCOMES: reduced incidence of depressive and anxiety disorder (especially major depression and generalised anxiety) in two years of SC versus UC (20% vs. 35%), decreased depression and anxiety symptoms (Hospital Anxiety and Depression Scale-Anxiety (HADS-A), CES-D), improved quality of life (EUROQuol), mortality, direct costs, and satisfaction with treatment. Assessments are 0, 3, 6, 12 and 24 months. POWER/ANALYSIS: we know from previous 75+ projects that two thirds of subjects complete the CES-D, and assume 40% will score 16 or more. They receive a validated psychiatric interview (Mini Neuropsychiatric Interview, MINI) to exclude depressive and anxiety disorders and other major psychiatric problems such as dementia at baseline (20%). We therefore need 1200 residents for 86 residents per arm. We expect substantial attrition. Samples of 67 patients are sufficient to detect a 15% difference in the primary outcome, the incidences, using survival analysis (20 vs. 35%), and to find moderate effects on the continuous outcome, depressive/anxiety symptoms at 12 months (standardized effect size d=0.50; power=0.80; alpha=0.05).

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Kenmerken

Projectnummer:
62200026
Looptijd: 100%
Looptijd: 100 %
2006
2011
Onderdeel van programma:
Projectleider en penvoerder:
Prof. dr. H.W.J. Marwijk
Verantwoordelijke organisatie:
Amsterdam UMC - locatie VUmc