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Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial
Weele, G.M. van der; Waal, M.W.M. de; Hout, W.B. van den; Craen, A.J.M. de; Spinhoven, P.; Stijnen, T.; ... ; Gussekloo, J. 2012
Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial
Article / Letter to editor
open access
Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial
Weele, G.M. van der; Waal, M.W.M. de; Hout, W.B. van den; Craen, A.J.M. de; Spinhoven, P.; Stijnen, T.; ... ; Gussekloo, J. 2012
Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial
Article / Letter to editor
open access
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... Show moreOBJECTIVES: 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. Show less
Yield and costs of direct and stepped screening for depressive symptoms in subjects aged 75 years and over in general practice
Weele, G.M. van der; Waal, M.W.M. de; Hout, W.B. van den; Mast, R.C. van der; Craen, A.J.M. de; Assendelft, W.J.J.; Gussekloo, J. 2011
Yield and costs of direct and stepped screening for depressive symptoms in subjects aged 75 years and over in general practice
Article / Letter to editor
open access
OBJECTIVE To examine yield and costs of two screening methods for depressive symptoms in subjects ≥75 years in general practice. METHODS In 73 general practices of 12.144 registered subjects ≥75... Show moreOBJECTIVE To examine yield and costs of two screening methods for depressive symptoms in subjects ≥75 years in general practice. METHODS In 73 general practices of 12.144 registered subjects ≥75 years 10.681 could be invited for screening. In the first 31 practices we invited 3797 subjects for direct screening which implied an invitation by letter followed by a home visit to administer the 15-item Geriatric Depression Scale (GDS-15). In the remaining 42 practices 6884 subjects were invited for stepped screening which implied that the GDS-15 was sent by post, followed by a home visit only if the self-administered GDS-15-score was ≥ 4 points. Being screen-positive for depressive symptoms was defined as an interviewer-administered GDS-15-score ≥5 points. Screening costs were estimated based on results in this study. RESULTS Of all registered subjects 707 (5.8%) were already being treated for depression. The yield of direct screening was higher than of stepped screening (2.6% versus 1.9%, p = 0.009), with similar yields for subjects aged 75-79 years and for subjects aged ≥80 years. In a standard GP-practice with 160 subjects ≥75 years estimated total screening costs are about twice as high for direct screening than for stepped screening. Estimated costs per screen positive subject are €350 for direct screening and €250 for stepped screening. CONCLUSION Direct screening has a higher yield, but is also more time consuming and more expensive. Whether the extra yield is clinically relevant and worth the extra costs, will depend on the subsequent treatment effect. Trial registration: www.controlled-trials.com/ISRCTN 71142851 Copyright © 2010 John Wiley & Sons, Ltd. Show less