A minimal psychological intervention in chronically ill elderly patients with depression: a randomized trial

Psychother Psychosom. 2010 Jun;79(4):217-26. doi: 10.1159/000313690. Epub 2010 Apr 29.


Background: Among older persons with chronic somatic diseases, depression often remains unrecognized and untreated in primary care. The Depression in Elderly with Long-Term Afflictions (DELTA) study aimed to evaluate the effectiveness of a nurse-led minimal psychological intervention (MPI) in chronically ill elderly persons with depression.

Methods: A randomized controlled trial was conducted, comparing the MPI with usual care in 361 primary care patients. Four nurses had an average of 4 sessions with the intervention patients, each lasting 1 h, over a maximum period of 3 months. Patients were aged 60 years and older, had a minor depression or mild-to-moderate major depression, and either had type II diabetes or chronic obstructive pulmonary disease.

Results: Nine months after the intervention, patients receiving the MPI had significantly fewer depressive symptoms; the intervention patients were also more likely than usual-care controls to show a >or=50% reduction in depressive symptoms relative to baseline values. At 9 months, diabetic MPI patients had a better quality of life than diabetic controls.

Conclusions: The nurse-led MPI appears to be a feasible and moderately effective method of managing minor-to-moderate depression in chronically ill elderly persons. However, we cannot rule out attention-placebo effects, and the disappointing finding of a recent economic evaluation showing only a 63% chance of the MPI being cost-effective. From a clinical point of view, however, it is of interest to further evaluate adaptations of the MPI, with a stronger emphasis on detection, watchful waiting and mental health problems in general.

Publication types

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

MeSH terms

  • Aged
  • Chronic Disease
  • Cognitive Behavioral Therapy / methods
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy*
  • Diabetes Mellitus, Type 2 / psychology
  • Female
  • Follow-Up Studies
  • Geriatric Assessment / methods
  • Geriatric Assessment / statistics & numerical data
  • Humans
  • Male
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychotherapy, Brief / methods*
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Quality of Life / psychology
  • Self Care / methods
  • Self Care / psychology
  • Severity of Illness Index
  • Treatment Outcome