Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial

Arch Gen Psychiatry. 2009 Mar;66(3):297-304. doi: 10.1001/archgenpsychiatry.2008.555.


Context: Given the public health significance of late-life depression and anxiety, and the limited capacity of treatment, there is an urgent need to develop effective strategies to prevent these disorders.

Objective: To determine the effectiveness of an indicated stepped-care prevention program for depression and anxiety disorders in the elderly.

Design: Randomized controlled trial with recruitment between October 1, 2004, and October 1, 2005.

Setting: Thirty-three primary care practices in the northwestern part of the Netherlands.

Participants: A total of 170 consenting individuals, 75 years and older, with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders.

Intervention: Participants were randomly assigned to a preventive stepped-care program (n = 86) or to usual care (n = 84). Stepped-care participants sequentially received a watchful waiting approach, cognitive behavior therapy-based bibliotherapy, cognitive behavior therapy-based problem-solving treatment, and referral to primary care for medication, if required.

Main outcome measures: The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview.

Results: The intervention halved the 12-month incidence of depressive and anxiety disorders, from 0.24 (20 of 84) in the usual care group to 0.12 (10 of 86) in the stepped-care group (relative risk, 0.49; 95% confidence interval, 0.24 to 0.98).

Conclusions: Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / prevention & control*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Cognitive Behavioral Therapy / methods*
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / prevention & control*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Male
  • Neuropsychological Tests
  • Primary Health Care / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Surveys and Questionnaires

Associated data

  • ISRCTN/ISRCTN26474556