Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial
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OBJECTIVES: to determine (cost)-effectiveness of a stepped-care intervention programme among subjects ≥ 75 years who screened positive for depressive symptoms in general practice. DESIGN: the pragmatic cluster-randomised controlled trial with 12-month follow-up. SETTING: sixty-seven Dutch general practices. SUBJECTS: two hundred and thirty-nine subjects ≥ 75 years screened positive for untreated depressive symptoms (15-item Geriatric Depression Scale ≥ 5). METHODS: usual care (34 practices, 118 subjects) was compared with the stepped-care intervention (33 practices, 121 subjects) consisting of three steps: individual counselling; Coping with Depression course; and-if indicated-referral back to general practitioner to discuss further treatment. Measurements included severity of depressive symptoms [Montgomery-Åsberg Depression Rating Scale (MADRS)], quality of life, mortality and costs. RESULTS: at baseline subjects mostly were mildly/moderately depressed. At 6 months MADRS scores had improved more in the usual care than the intervention group (-2.9 versus -1.1 points, P=0.032), but not at 12 months (-3.1 versus -4.6, P=0.084). No significant differences were found within two separate age groups (75-79 years and ≥ 80 years). In intervention practices, 83% accepted referral to the stepped-care programme, and 19% accepted course participation. The control group appeared to have received more psychological care. CONCLUSIONS: among older subjects who screened positive for depressive symptoms, an offered stepped-care intervention programme was not (cost)-effective compared with usual care, possibly due to a low uptake of the course offer. TRIAL REGISTRATION: www.controlled-trials.com/ISRCTN 71142851v.
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Assuming a mean cluster size of five patients per counselor, an intraclass correlation coefficient of 0.01, and a coefficient of variation of 0.30, 18 mental health counselors in each intervention arm and 90 participants per study arm are needed to detect a between-group difference on the GAD-7 with a medium effect size of d = 0.45, an alpha of 0.05 two-tailed, and a power of 0.80.
“Assuming a mean cluster size of five patients per counselor, an intraclass correlation coefficient of 0.01 [52] and a coefficient of variation of 0.30 [53], 18 mental health counselors in each intervention arm and 90 participants per study arm are needed to detect a between group difference on the GAD-7 with a medium effect size (d = 0.45) with an alpha of 0.05 (two-tailed) and a power of 0.80.”
From An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. (2018) · cites this paper as [52]
The citation is attached to the assumed intraclass correlation coefficient of 0.01. The paper’s Sample size calculation section instead states that it assumed an ICC of 0.2 for its cluster-randomised trial; it does not support the cited value of 0.01. (LLM, conf=0.90)
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- Authors
- van der Weele, G. M., de Waal, M. W. M., van den Hout, W. B., de Craen, A. J. M., Spinhoven, P., Stijnen, T., Assendelft, W. J. J., van der Mast, R. C., & Gussekloo, J.
- Affiliations
- Leiden University Medical Center (NL)
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-03-16
- Volume
- 41
- Issue
- 4
- Pages
- 482-488
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W2065660631
- Cited by
- 39
- References
- 27
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 2 · 2021: 4 · 2020: 1 · 2019: 3 · 2018: 6 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 5 · 2013: 4 · 2012: 1
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- ZonMw (945-07-502)
- Rivierduinen
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- stepped-care intervention, depressive symptoms, older adults, geriatric depression, cost-effectiveness, general practice, Geriatric Depression Scale, individual counseling, general practitioner referral, quality of life, mortality
- MeSH terms
- Adaptation, Psychological, Age Factors, Aged, Aged, 80 and over, Aging, Cost-Benefit Analysis, Counseling, Depression, Female, Health Services for the Aged, House Calls, Humans, Health Knowledge, Attitudes, Practice, Male, Mental Health Services, Motivation, Netherlands, Patient Acceptance of Health Care, Patient Education as Topic, Psychiatric Status Rating Scales, Referral and Consultation, Severity of Illness Index, Cluster Analysis, Proportional Hazards Models, Treatment Outcome, Health Care Costs, General Practice
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